{ "hospital_name": "Saint Francis Hospital", "last_updated_on": "2025-12-09","version": "2.2.0", "hospital_location": ["Saint Francis Hospital"],"hospital_address": [ "355 Ridge Ave., Evanston, Illinois 60202" ], "license_information": { "license_number": "992441755", "state": "IL" }, "affirmation": { "affirmation": "To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.", "confirm_affirmation": true } , "standard_charge_information": [ { "description": "Hc Cerbral Perfusion Study, Ct W/ Contrast", "code_information": [ { "code": "0042T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 955,"minimum": 191,"maximum": 824,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 324.7, "standard_charge_percentage": 34.0000, "estimated_amount": 324, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 792.65, "standard_charge_percentage": 83.0000, "estimated_amount": 792, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 764, "standard_charge_percentage": 80.0000, "estimated_amount": 764, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 381.74, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 800, "estimated_amount": 800, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 472.5, "standard_charge_percentage": 53.2000, "estimated_amount": 472, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 824, "estimated_amount": 824, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 400.83, "estimated_amount": 400, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 249.25, "standard_charge_percentage": 26.1000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 764, "standard_charge_percentage": 80.0000, "estimated_amount": 764, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 482.66, "standard_charge_percentage": 53.2000, "estimated_amount": 482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 191, "standard_charge_percentage": 20.0000, "estimated_amount": 191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 508.06, "standard_charge_percentage": 53.2000, "estimated_amount": 508, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 209.15, "standard_charge_percentage": 21.9000, "estimated_amount": 209, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 764, "standard_charge_percentage": 80.0000, "estimated_amount": 764, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 668.5, "standard_charge_percentage": 70.0000, "estimated_amount": 668, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 238.75, "standard_charge_percentage": 25.0000, "estimated_amount": 238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 286.5, "standard_charge_percentage": 30.0000, "estimated_amount": 286, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 716.25, "standard_charge_percentage": 75.0000, "estimated_amount": 716, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 400.83, "estimated_amount": 400, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 381.74, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 678.05, "standard_charge_percentage": 71.0000, "estimated_amount": 678, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 564.4, "standard_charge_percentage": 59.1000, "estimated_amount": 564, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 209.15, "standard_charge_percentage": 21.9000, "estimated_amount": 209, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 381.74, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 209.15, "standard_charge_percentage": 21.9000, "estimated_amount": 209, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 381.74, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 262.63, "standard_charge_percentage": 27.5000, "estimated_amount": 262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 381.74, "estimated_amount": 381, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 764, "standard_charge_percentage": 80.0000, "estimated_amount": 764, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 764, "standard_charge_percentage": 80.0000, "estimated_amount": 764, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 286.5, "standard_charge_percentage": 30.0000, "estimated_amount": 286, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 620.75, "standard_charge_percentage": 65.0000, "estimated_amount": 620, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 381.74, "estimated_amount": 381, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "0054T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46468,"minimum": 1169,"maximum": 38568.4,"payers_information":[{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 37174.4, "standard_charge_percentage": 80.0000, "estimated_amount": 37174, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 37174.4, "standard_charge_percentage": 80.0000, "estimated_amount": 37174, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 37174.4, "standard_charge_percentage": 80.0000, "estimated_amount": 37174, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 11617, "standard_charge_percentage": 25.0000, "estimated_amount": 11617, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 15799.1, "standard_charge_percentage": 34.0000, "estimated_amount": 15799, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 37174.4, "standard_charge_percentage": 80.0000, "estimated_amount": 37174, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 23484.9, "standard_charge_percentage": 53.2000, "estimated_amount": 23484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 24721, "standard_charge_percentage": 53.2000, "estimated_amount": 24720, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 32992.3, "standard_charge_percentage": 71.0000, "estimated_amount": 32992, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 37174.4, "standard_charge_percentage": 80.0000, "estimated_amount": 37174, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 13940.4, "standard_charge_percentage": 30.0000, "estimated_amount": 13940, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 38568.4, "standard_charge_percentage": 83.0000, "estimated_amount": 38568, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 22990.5, "standard_charge_percentage": 53.2000, "estimated_amount": 22990, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 9528, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 9528, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 32527.6, "standard_charge_percentage": 70.0000, "estimated_amount": 32527, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 34851, "standard_charge_percentage": 75.0000, "estimated_amount": 34851, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8889, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 9293.6, "standard_charge_percentage": 20.0000, "estimated_amount": 9293, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 13940.4, "standard_charge_percentage": 30.0000, "estimated_amount": 13940, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 30204.2, "standard_charge_percentage": 65.0000, "estimated_amount": 30204, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "0055T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18290.5,"minimum": 1169,"maximum": 15181.1,"payers_information":[{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3658.1, "standard_charge_percentage": 20.0000, "estimated_amount": 3658, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 4005.62, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 4005, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 4005.62, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 4005, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4773.82, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4773, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 11888.8, "standard_charge_percentage": 65.0000, "estimated_amount": 11888, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 12986.3, "standard_charge_percentage": 71.0000, "estimated_amount": 12986, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 9244.02, "standard_charge_percentage": 53.2000, "estimated_amount": 9244, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 9730.55, "standard_charge_percentage": 53.2000, "estimated_amount": 9730, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5487.15, "standard_charge_percentage": 30.0000, "estimated_amount": 5487, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 5029.89, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 5029, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 12803.4, "standard_charge_percentage": 70.0000, "estimated_amount": 12803, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 4572.63, "standard_charge_percentage": 25.0000, "estimated_amount": 4572, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 15181.1, "standard_charge_percentage": 83.0000, "estimated_amount": 15181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 6218.77, "standard_charge_percentage": 34.0000, "estimated_amount": 6218, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 13717.9, "standard_charge_percentage": 75.0000, "estimated_amount": 13717, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14632.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14632, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 9049.41, "standard_charge_percentage": 53.2000, "estimated_amount": 9049, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 5487.15, "standard_charge_percentage": 30.0000, "estimated_amount": 5487, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 14632.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14632, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 14632.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14632, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 5852.96, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 5852, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14632.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14632, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 14632.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14632, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 4005.62, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 4005, "methodology": "percent of total billed charges" }]}]} , { "description": "Perq sacral augmt bilat inj", "code_information": [ { "code": "0201T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10890, "discounted_cash": 9680,"minimum": 232,"maximum": 10890,"payers_information":[{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2842.29, "standard_charge_percentage": 26.1000, "estimated_amount": 2842, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8712, "standard_charge_percentage": 80.0000, "estimated_amount": 8712, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1467, "estimated_amount": 1467, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7731.9, "standard_charge_percentage": 71.0000, "estimated_amount": 7731, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7623, "standard_charge_percentage": 70.0000, "estimated_amount": 7623, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 10890, "estimated_amount": 10890, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 10890, "estimated_amount": 10890, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5387.94, "standard_charge_percentage": 53.2000, "estimated_amount": 5387, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 8167.5, "standard_charge_percentage": 75.0000, "estimated_amount": 8167, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2994.75, "standard_charge_percentage": 27.5000, "estimated_amount": 2994, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 5793.48, "standard_charge_percentage": 53.2000, "estimated_amount": 5793, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6196.79, "estimated_amount": 6196, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6196.79, "estimated_amount": 6196, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 9038.7, "standard_charge_percentage": 83.0000, "estimated_amount": 9038, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 6435.99, "standard_charge_percentage": 59.1000, "estimated_amount": 6435, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6196.79, "estimated_amount": 6196, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6506.63, "estimated_amount": 6506, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 10890, "estimated_amount": 10890, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2384.91, "standard_charge_percentage": 21.9000, "estimated_amount": 2384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5503.81, "standard_charge_percentage": 53.2000, "estimated_amount": 5503, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3702.6, "standard_charge_percentage": 34.0000, "estimated_amount": 3702, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6196.79, "estimated_amount": 6196, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 10890, "estimated_amount": 10890, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 232, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8712, "standard_charge_percentage": 80.0000, "estimated_amount": 8712, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2384.91, "standard_charge_percentage": 21.9000, "estimated_amount": 2384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3267, "standard_charge_percentage": 30.0000, "estimated_amount": 3267, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8712, "standard_charge_percentage": 80.0000, "estimated_amount": 8712, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 10890, "estimated_amount": 10890, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7078.5, "standard_charge_percentage": 65.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6196.79, "estimated_amount": 6196, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2178, "standard_charge_percentage": 20.0000, "estimated_amount": 2178, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8712, "standard_charge_percentage": 80.0000, "estimated_amount": 8712, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6506.63, "estimated_amount": 6506, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 8929.8, "standard_charge_percentage": 82.0000, "estimated_amount": 8929, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8712, "standard_charge_percentage": 80.0000, "estimated_amount": 8712, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 3267, "standard_charge_percentage": 30.0000, "estimated_amount": 3267, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6196.79, "estimated_amount": 6196, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2384.91, "standard_charge_percentage": 21.9000, "estimated_amount": 2384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "0232T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5421.5, "discounted_cash": 540,"minimum": 395.16,"maximum": 4550,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1187.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4337.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4337, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 4499.85, "standard_charge_percentage": 83.0000, "estimated_amount": 4499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 457.56, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1626.45, "standard_charge_percentage": 30.0000, "estimated_amount": 1626, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.15, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 519.95, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 2682.34, "standard_charge_percentage": 53.2000, "estimated_amount": 2682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1084.3, "standard_charge_percentage": 20.0000, "estimated_amount": 1084, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 644.74, "estimated_amount": 644, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1187.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.44, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1734.88, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 1734, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3523.97, "standard_charge_percentage": 65.0000, "estimated_amount": 3523, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 673.86, "estimated_amount": 673, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4337.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4337, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 507.09, "estimated_amount": 507, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 507.09, "estimated_amount": 507, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 436.76, "estimated_amount": 436, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 532.44, "estimated_amount": 532, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1187.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.35, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 507.09, "estimated_amount": 507, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1843.31, "standard_charge_percentage": 34.0000, "estimated_amount": 1843, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2884.24, "standard_charge_percentage": 53.2000, "estimated_amount": 2884, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 644.74, "estimated_amount": 644, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 436.76, "estimated_amount": 436, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 532.44, "estimated_amount": 532, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 623.94, "estimated_amount": 623, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.44, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1355.38, "standard_charge_percentage": 25.0000, "estimated_amount": 1355, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 561.55, "estimated_amount": 561, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 507.09, "estimated_amount": 507, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1490.91, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1490, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 582.34, "estimated_amount": 582, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 407.64, "estimated_amount": 407, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4337.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4337, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4066.13, "standard_charge_percentage": 75.0000, "estimated_amount": 4066, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 948.72, "estimated_amount": 948, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.16, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1415.01, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3849.26, "standard_charge_percentage": 71.0000, "estimated_amount": 3849, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 507.09, "estimated_amount": 507, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 436.76, "estimated_amount": 436, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4337.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4337, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4337.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4337, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 436.76, "estimated_amount": 436, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.44, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3795.05, "standard_charge_percentage": 70.0000, "estimated_amount": 3795, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1626.45, "standard_charge_percentage": 30.0000, "estimated_amount": 1626, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 507.09, "estimated_amount": 507, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 2740.03, "standard_charge_percentage": 53.2000, "estimated_amount": 2740, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "0275T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11097, "discounted_cash": 9680,"minimum": 1467,"maximum": 11097,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 5359.85, "standard_charge_percentage": 48.3000, "estimated_amount": 5359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11097, "estimated_amount": 11097, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3051.68, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3051, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6506.63, "estimated_amount": 6506, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6506.63, "estimated_amount": 6506, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 3329.1, "standard_charge_percentage": 30.0000, "estimated_amount": 3329, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3772.98, "standard_charge_percentage": 34.0000, "estimated_amount": 3772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6196.79, "estimated_amount": 6196, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6196.79, "estimated_amount": 6196, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11097, "estimated_amount": 11097, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6196.79, "estimated_amount": 6196, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3551.04, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 3551, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7213.05, "standard_charge_percentage": 65.0000, "estimated_amount": 7213, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 9210.51, "standard_charge_percentage": 83.0000, "estimated_amount": 9210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 11097, "estimated_amount": 11097, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6196.79, "estimated_amount": 6196, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 5903.6, "standard_charge_percentage": 53.2000, "estimated_amount": 5903, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2219.4, "standard_charge_percentage": 20.0000, "estimated_amount": 2219, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3329.1, "standard_charge_percentage": 30.0000, "estimated_amount": 3329, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 8322.75, "standard_charge_percentage": 75.0000, "estimated_amount": 8322, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7878.87, "standard_charge_percentage": 71.0000, "estimated_amount": 7878, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5608.42, "standard_charge_percentage": 53.2000, "estimated_amount": 5608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1467, "estimated_amount": 1467, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7767.9, "standard_charge_percentage": 70.0000, "estimated_amount": 7767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6196.79, "estimated_amount": 6196, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11097, "estimated_amount": 11097, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2896.32, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2896, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5490.35, "standard_charge_percentage": 53.2000, "estimated_amount": 5490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 11097, "estimated_amount": 11097, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6196.79, "estimated_amount": 6196, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2430, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "0479T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8652, "discounted_cash": 829,"minimum": 479.38,"maximum": 7181.16,"payers_information":[{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6056.4, "standard_charge_percentage": 70.0000, "estimated_amount": 6056, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1730.4, "standard_charge_percentage": 20.0000, "estimated_amount": 1730, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6489, "standard_charge_percentage": 75.0000, "estimated_amount": 6489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 797.61, "estimated_amount": 797, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4602.86, "standard_charge_percentage": 53.2000, "estimated_amount": 4602, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1894.79, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1894, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2941.68, "standard_charge_percentage": 34.0000, "estimated_amount": 2941, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4280.66, "standard_charge_percentage": 53.2000, "estimated_amount": 4280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 2595.6, "standard_charge_percentage": 30.0000, "estimated_amount": 2595, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1033.71, "estimated_amount": 1033, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 893.33, "estimated_amount": 893, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 957.13, "estimated_amount": 957, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1455.36, "estimated_amount": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6142.92, "standard_charge_percentage": 71.0000, "estimated_amount": 6142, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1894.79, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1894, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 606.19, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 733.8, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2258.17, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2258, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 2163, "standard_charge_percentage": 25.0000, "estimated_amount": 2163, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2768.64, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2768, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 861.42, "estimated_amount": 861, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 625.33, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 765.71, "estimated_amount": 765, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4372.72, "standard_charge_percentage": 53.2000, "estimated_amount": 4372, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2595.6, "standard_charge_percentage": 30.0000, "estimated_amount": 2595, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2379.3, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2379, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5623.8, "standard_charge_percentage": 65.0000, "estimated_amount": 5623, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 701.9, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7181.16, "standard_charge_percentage": 83.0000, "estimated_amount": 7181, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1894.79, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1894, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 989.04, "estimated_amount": 989, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 989.04, "estimated_amount": 989, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "0482U", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 906.25, "discounted_cash": 167,"minimum": 47.44,"maximum": 752.19,"payers_information":[{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 226.56, "standard_charge_percentage": 25.0000, "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 193.23, "estimated_amount": 193, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 47.44, "estimated_amount": 47, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 725, "standard_charge_percentage": 80.0000, "estimated_amount": 725, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 154.58, "estimated_amount": 154, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 49.81, "estimated_amount": 49, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 128.82, "estimated_amount": 128, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 236.53, "standard_charge_percentage": 26.1000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 132.68, "estimated_amount": 132, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 161.02, "estimated_amount": 161, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 128.82, "estimated_amount": 128, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 148.14, "estimated_amount": 148, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 458.02, "standard_charge_percentage": 53.2000, "estimated_amount": 458, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 128.82, "estimated_amount": 128, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 135.26, "estimated_amount": 135, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 198.47, "standard_charge_percentage": 21.9000, "estimated_amount": 198, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 135.26, "estimated_amount": 135, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 128.82, "estimated_amount": 128, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 128.82, "estimated_amount": 128, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 47.44, "estimated_amount": 47, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 132.68, "estimated_amount": 132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 180.35, "estimated_amount": 180, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 643.44, "standard_charge_percentage": 71.0000, "estimated_amount": 643, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 271.88, "standard_charge_percentage": 30.0000, "estimated_amount": 271, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 752.19, "standard_charge_percentage": 83.0000, "estimated_amount": 752, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 208.69, "estimated_amount": 208, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 128.82, "estimated_amount": 128, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 128.82, "estimated_amount": 128, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 198.47, "standard_charge_percentage": 21.9000, "estimated_amount": 198, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 589.06, "standard_charge_percentage": 65.0000, "estimated_amount": 589, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 173.91, "estimated_amount": 173, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 199.67, "estimated_amount": 199, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 122.38, "estimated_amount": 122, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 743.13, "standard_charge_percentage": 82.0000, "estimated_amount": 743, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 132.68, "estimated_amount": 132, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 77.29, "estimated_amount": 77, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 271.88, "standard_charge_percentage": 30.0000, "estimated_amount": 271, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 128.82, "estimated_amount": 128, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 448.38, "standard_charge_percentage": 53.2000, "estimated_amount": 448, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 181.25, "standard_charge_percentage": 20.0000, "estimated_amount": 181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 199.67, "estimated_amount": 199, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 47.44, "estimated_amount": 47, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 679.69, "standard_charge_percentage": 75.0000, "estimated_amount": 679, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 47.44, "estimated_amount": 47, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 128.82, "estimated_amount": 128, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 725, "standard_charge_percentage": 80.0000, "estimated_amount": 725, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 135.26, "estimated_amount": 135, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 128.82, "estimated_amount": 128, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 725, "standard_charge_percentage": 80.0000, "estimated_amount": 725, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 135.26, "estimated_amount": 135, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 47.44, "estimated_amount": 47, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 198.47, "standard_charge_percentage": 21.9000, "estimated_amount": 198, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 154.58, "estimated_amount": 154, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 535.59, "standard_charge_percentage": 59.1000, "estimated_amount": 535, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 128.82, "estimated_amount": 128, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 308.13, "standard_charge_percentage": 34.0000, "estimated_amount": 308, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 128.82, "estimated_amount": 128, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 725, "standard_charge_percentage": 80.0000, "estimated_amount": 725, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 128.82, "estimated_amount": 128, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 128.82, "estimated_amount": 128, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 249.22, "standard_charge_percentage": 27.5000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 128.82, "estimated_amount": 128, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 128.82, "estimated_amount": 128, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 141.7, "estimated_amount": 141, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 634.38, "standard_charge_percentage": 70.0000, "estimated_amount": 634, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 128.82, "estimated_amount": 128, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 126.24, "estimated_amount": 126, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 128.82, "estimated_amount": 128, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 49.81, "estimated_amount": 49, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 725, "standard_charge_percentage": 80.0000, "estimated_amount": 725, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 186.79, "estimated_amount": 186, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 47.44, "estimated_amount": 47, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 482.13, "standard_charge_percentage": 53.2000, "estimated_amount": 482, "methodology": "percent of total billed charges" }]}]} , { "description": "Quan ct tiss charac wct", "code_information": [ { "code": "0722T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3253, "discounted_cash": 881,"minimum": 134,"maximum": 2699.99,"payers_information":[{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 678.09, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 824, "estimated_amount": 824, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 698.43, "estimated_amount": 698, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 915.42, "estimated_amount": 915, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 678.09, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 711.99, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 134.01, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 678.09, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 2439.75, "standard_charge_percentage": 75.0000, "estimated_amount": 2439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1644.07, "standard_charge_percentage": 53.2000, "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 678.09, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 711.99, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1730.6, "standard_charge_percentage": 53.2000, "estimated_amount": 1730, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 134.01, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 678.09, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 140.71, "estimated_amount": 140, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 678.09, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 678.09, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1609.45, "standard_charge_percentage": 53.2000, "estimated_amount": 1609, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 134.01, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 2602.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2602, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1017.13, "estimated_amount": 1017, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 134.01, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 678.09, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 800, "estimated_amount": 800, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 712.41, "standard_charge_percentage": 21.9000, "estimated_amount": 712, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 2602.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2602, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2309.63, "standard_charge_percentage": 71.0000, "estimated_amount": 2309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 711.99, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 813.71, "estimated_amount": 813, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 698.43, "estimated_amount": 698, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 2699.99, "standard_charge_percentage": 83.0000, "estimated_amount": 2699, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 2602.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2602, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 975.9, "standard_charge_percentage": 30.0000, "estimated_amount": 975, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 678.09, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 712.41, "standard_charge_percentage": 21.9000, "estimated_amount": 712, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 644.19, "estimated_amount": 644, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 894.58, "standard_charge_percentage": 27.5000, "estimated_amount": 894, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 779.8, "estimated_amount": 779, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 847.61, "estimated_amount": 847, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 140.71, "estimated_amount": 140, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2277.1, "standard_charge_percentage": 70.0000, "estimated_amount": 2277, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 678.09, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 678.09, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 698.43, "estimated_amount": 698, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2114.45, "standard_charge_percentage": 65.0000, "estimated_amount": 2114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 134.01, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 678.09, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2602.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2602, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1051.04, "estimated_amount": 1051, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 678.09, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 678.09, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 678.09, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1051.04, "estimated_amount": 1051, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1546.59, "estimated_amount": 1546, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 949.33, "estimated_amount": 949, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 711.99, "estimated_amount": 711, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 678.09, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1106.02, "standard_charge_percentage": 34.0000, "estimated_amount": 1106, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 650.6, "standard_charge_percentage": 20.0000, "estimated_amount": 650, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 712.41, "standard_charge_percentage": 21.9000, "estimated_amount": 712, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 678.09, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 975.9, "standard_charge_percentage": 30.0000, "estimated_amount": 975, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2602.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2602, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 134.01, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 678.09, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 664.53, "estimated_amount": 664, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1922.52, "standard_charge_percentage": 59.1000, "estimated_amount": 1922, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 849.03, "standard_charge_percentage": 26.1000, "estimated_amount": 849, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 745.9, "estimated_amount": 745, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1098.51, "estimated_amount": 1098, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 813.25, "standard_charge_percentage": 25.0000, "estimated_amount": 813, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 678.09, "estimated_amount": 678, "methodology": "fee schedule" }]}]} , { "description": "FNA BX US GUIDANCE 1ST LESION", "code_information": [ { "code": "10005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1818, "discounted_cash": 953,"minimum": 136.42,"maximum": 1818,"payers_information":[{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1454.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1454, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 900.41, "estimated_amount": 900, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 900.41, "estimated_amount": 900, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1272.6, "standard_charge_percentage": 70.0000, "estimated_amount": 1272, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 499.95, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1454.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1454, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1188.16, "estimated_amount": 1188, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 136.42, "estimated_amount": 136, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 454.5, "standard_charge_percentage": 25.0000, "estimated_amount": 454, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1454.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1454, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 136.42, "estimated_amount": 136, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 363.6, "standard_charge_percentage": 20.0000, "estimated_amount": 363, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 1508.94, "standard_charge_percentage": 83.0000, "estimated_amount": 1508, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 398.14, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 398, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 398.14, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 398, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 581.76, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 581, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1363.5, "standard_charge_percentage": 75.0000, "estimated_amount": 1363, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1672.81, "estimated_amount": 1672, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1181.7, "standard_charge_percentage": 65.0000, "estimated_amount": 1181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 545.4, "standard_charge_percentage": 30.0000, "estimated_amount": 545, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 899.47, "standard_charge_percentage": 53.2000, "estimated_amount": 899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 618.12, "standard_charge_percentage": 34.0000, "estimated_amount": 618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1454.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1454, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 967.18, "standard_charge_percentage": 53.2000, "estimated_amount": 967, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 398.14, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 398, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 474.5, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 474, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1454.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1454, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1290.78, "standard_charge_percentage": 71.0000, "estimated_amount": 1290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 918.82, "standard_charge_percentage": 53.2000, "estimated_amount": 918, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1818, "estimated_amount": 1818, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" }]}]} , { "description": "FNA BX US GDN EA ADDL LESION", "code_information": [ { "code": "10006", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 606,"minimum": 62.26,"maximum": 606,"payers_information":[{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 193.92, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 193, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 132.71, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 132, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 606, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 606, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 181.8, "standard_charge_percentage": 30.0000, "estimated_amount": 181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 430.26, "standard_charge_percentage": 71.0000, "estimated_amount": 430, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 132.71, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 132, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 484.8, "standard_charge_percentage": 80.0000, "estimated_amount": 484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 484.8, "standard_charge_percentage": 80.0000, "estimated_amount": 484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 484.8, "standard_charge_percentage": 80.0000, "estimated_amount": 484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 606, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 606, "estimated_amount": 606, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 206.04, "standard_charge_percentage": 34.0000, "estimated_amount": 206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 121.2, "standard_charge_percentage": 20.0000, "estimated_amount": 121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 606, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 393.9, "standard_charge_percentage": 65.0000, "estimated_amount": 393, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 484.8, "standard_charge_percentage": 80.0000, "estimated_amount": 484, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 299.82, "standard_charge_percentage": 53.2000, "estimated_amount": 299, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 424.2, "standard_charge_percentage": 70.0000, "estimated_amount": 424, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 62.26, "estimated_amount": 62, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 151.5, "standard_charge_percentage": 25.0000, "estimated_amount": 151, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 166.65, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 166, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 306.27, "standard_charge_percentage": 53.2000, "estimated_amount": 306, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 502.98, "standard_charge_percentage": 83.0000, "estimated_amount": 502, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 322.39, "standard_charge_percentage": 53.2000, "estimated_amount": 322, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 606, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 62.26, "estimated_amount": 62, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 606, "estimated_amount": 606, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 484.8, "standard_charge_percentage": 80.0000, "estimated_amount": 484, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 454.5, "standard_charge_percentage": 75.0000, "estimated_amount": 454, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 132.71, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 132, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 606, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 158.17, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 158, "methodology": "percent of total billed charges" }]}]} , { "description": "Fna bx wct gdn 1st les", "code_information": [ { "code": "10009", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1818, "discounted_cash": 953,"minimum": 363.6,"maximum": 1818,"payers_information":[{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1454.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1454, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 618.12, "standard_charge_percentage": 34.0000, "estimated_amount": 618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 1508.94, "standard_charge_percentage": 83.0000, "estimated_amount": 1508, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 474.5, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 474, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1454.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1454, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1181.7, "standard_charge_percentage": 65.0000, "estimated_amount": 1181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 420.87, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 581.76, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 581, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 398.14, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 398, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 398.14, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 398, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1272.6, "standard_charge_percentage": 70.0000, "estimated_amount": 1272, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1454.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1454, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 900.41, "estimated_amount": 900, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1363.5, "standard_charge_percentage": 75.0000, "estimated_amount": 1363, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 967.18, "standard_charge_percentage": 53.2000, "estimated_amount": 967, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1818, "estimated_amount": 1818, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 499.95, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 420.87, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 545.4, "standard_charge_percentage": 30.0000, "estimated_amount": 545, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 363.6, "standard_charge_percentage": 20.0000, "estimated_amount": 363, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1454.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1454, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1454.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1454, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1290.78, "standard_charge_percentage": 71.0000, "estimated_amount": 1290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1188.16, "estimated_amount": 1188, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 918.82, "standard_charge_percentage": 53.2000, "estimated_amount": 918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 454.5, "standard_charge_percentage": 25.0000, "estimated_amount": 454, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 398.14, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 398, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1672.81, "estimated_amount": 1672, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 899.47, "standard_charge_percentage": 53.2000, "estimated_amount": 899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 900.41, "estimated_amount": 900, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" }]}]} , { "description": "ENDOVENOUS RF VEIN ADD-ON", "code_information": [ { "code": "10021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 781, "discounted_cash": 541,"minimum": 104.23,"maximum": 781,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 265.54, "standard_charge_percentage": 34.0000, "estimated_amount": 265, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 781, "estimated_amount": 781, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 781, "estimated_amount": 781, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 249.92, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 171.04, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 322.33, "estimated_amount": 322, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 781, "estimated_amount": 781, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 234.3, "standard_charge_percentage": 30.0000, "estimated_amount": 234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 339.3, "estimated_amount": 339, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 585.75, "standard_charge_percentage": 75.0000, "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 171.04, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 624.8, "standard_charge_percentage": 80.0000, "estimated_amount": 624, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 624.8, "standard_charge_percentage": 80.0000, "estimated_amount": 624, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 171.04, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 171, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 781, "estimated_amount": 781, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 156.2, "standard_charge_percentage": 20.0000, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 624.8, "standard_charge_percentage": 80.0000, "estimated_amount": 624, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 203.84, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 624.8, "standard_charge_percentage": 80.0000, "estimated_amount": 624, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 781, "estimated_amount": 781, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 195.25, "standard_charge_percentage": 25.0000, "estimated_amount": 195, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 214.78, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 214, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 315.55, "estimated_amount": 315, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 674.68, "estimated_amount": 674, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 781, "estimated_amount": 781, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 554.51, "standard_charge_percentage": 71.0000, "estimated_amount": 554, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 507.65, "standard_charge_percentage": 65.0000, "estimated_amount": 507, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 624.8, "standard_charge_percentage": 80.0000, "estimated_amount": 624, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 781, "estimated_amount": 781, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 781, "estimated_amount": 781, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 781, "estimated_amount": 781, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 546.7, "standard_charge_percentage": 70.0000, "estimated_amount": 546, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 781, "estimated_amount": 781, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 104.23, "estimated_amount": 104, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 648.23, "standard_charge_percentage": 83.0000, "estimated_amount": 648, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 104.23, "estimated_amount": 104, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 781, "estimated_amount": 781, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" }]}]} , { "description": "INS ENDOVAS VENA CAVA FILTR", "code_information": [ { "code": "10030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2420, "discounted_cash": 953,"minimum": 484,"maximum": 2420,"payers_information":[{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1718.2, "standard_charge_percentage": 71.0000, "estimated_amount": 1718, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1347.12, "estimated_amount": 1347, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1815, "standard_charge_percentage": 75.0000, "estimated_amount": 1815, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1414.48, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1347.12, "estimated_amount": 1347, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1936, "standard_charge_percentage": 80.0000, "estimated_amount": 1936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1414.48, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 529.98, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 605, "standard_charge_percentage": 25.0000, "estimated_amount": 605, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 484, "standard_charge_percentage": 20.0000, "estimated_amount": 484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 774.4, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1188.16, "estimated_amount": 1188, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1347.12, "estimated_amount": 1347, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 822.8, "standard_charge_percentage": 34.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 529.98, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1936, "standard_charge_percentage": 80.0000, "estimated_amount": 1936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 529.98, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1936, "standard_charge_percentage": 80.0000, "estimated_amount": 1936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 2420, "estimated_amount": 2420, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1672.81, "estimated_amount": 1672, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1694, "standard_charge_percentage": 70.0000, "estimated_amount": 1694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1197.32, "standard_charge_percentage": 53.2000, "estimated_amount": 1197, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1936, "standard_charge_percentage": 80.0000, "estimated_amount": 1936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1347.12, "estimated_amount": 1347, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 665.5, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 665, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1347.12, "estimated_amount": 1347, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 622.07, "estimated_amount": 622, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1573, "standard_charge_percentage": 65.0000, "estimated_amount": 1573, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1287.44, "standard_charge_percentage": 53.2000, "estimated_amount": 1287, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 2008.6, "standard_charge_percentage": 83.0000, "estimated_amount": 2008, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1347.12, "estimated_amount": 1347, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 622.07, "estimated_amount": 622, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 631.62, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 631, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1223.07, "standard_charge_percentage": 53.2000, "estimated_amount": 1223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1936, "standard_charge_percentage": 80.0000, "estimated_amount": 1936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 726, "standard_charge_percentage": 30.0000, "estimated_amount": 726, "methodology": "percent of total billed charges" }]}]} , { "description": "Plmt sft tiss loclzj dev 1st", "code_information": [ { "code": "10035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3603, "discounted_cash": 953,"minimum": 352.05,"maximum": 3603,"payers_information":[{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1188.16, "estimated_amount": 1188, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 2882.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2882, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1225.02, "standard_charge_percentage": 34.0000, "estimated_amount": 1225, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 789.06, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1347.12, "estimated_amount": 1347, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 2882.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2882, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2882.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2882, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 352.05, "estimated_amount": 352, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1347.12, "estimated_amount": 1347, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1347.12, "estimated_amount": 1347, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2522.1, "standard_charge_percentage": 70.0000, "estimated_amount": 2522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1080.9, "standard_charge_percentage": 30.0000, "estimated_amount": 1080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1414.48, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 2990.49, "standard_charge_percentage": 83.0000, "estimated_amount": 2990, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1782.62, "standard_charge_percentage": 53.2000, "estimated_amount": 1782, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 352.05, "estimated_amount": 352, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3603, "estimated_amount": 3603, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 2882.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2882, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2341.95, "standard_charge_percentage": 65.0000, "estimated_amount": 2341, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 2702.25, "standard_charge_percentage": 75.0000, "estimated_amount": 2702, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 789.06, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 789, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1414.48, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 720.6, "standard_charge_percentage": 20.0000, "estimated_amount": 720, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1672.81, "estimated_amount": 1672, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1347.12, "estimated_amount": 1347, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1347.12, "estimated_amount": 1347, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 940.38, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 940, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1916.8, "standard_charge_percentage": 53.2000, "estimated_amount": 1916, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 789.06, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1347.12, "estimated_amount": 1347, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2558.13, "standard_charge_percentage": 71.0000, "estimated_amount": 2558, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1820.96, "standard_charge_percentage": 53.2000, "estimated_amount": 1820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 990.83, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 990, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1152.96, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 1152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2882.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2882, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" }]}]} , { "description": "Hc Incision & Drain Skin Abscess Simple", "code_information": [ { "code": "10060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 311, "discounted_cash": 269,"minimum": 62.2,"maximum": 311,"payers_information":[{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 217.7, "standard_charge_percentage": 70.0000, "estimated_amount": 217, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 68.11, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 68, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 99.52, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 99, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 248.8, "standard_charge_percentage": 80.0000, "estimated_amount": 248, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 258.13, "standard_charge_percentage": 83.0000, "estimated_amount": 258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 311, "estimated_amount": 311, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 77.75, "standard_charge_percentage": 25.0000, "estimated_amount": 77, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 62.2, "standard_charge_percentage": 20.0000, "estimated_amount": 62, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 310.68, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 81.17, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 81, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 258.9, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 68.11, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 68, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 311, "estimated_amount": 311, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 311, "estimated_amount": 311, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 279.61, "estimated_amount": 279, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 248.8, "standard_charge_percentage": 80.0000, "estimated_amount": 248, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 248.54, "estimated_amount": 248, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 130.62, "estimated_amount": 130, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 202.98, "estimated_amount": 202, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 202.15, "standard_charge_percentage": 65.0000, "estimated_amount": 202, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 105.74, "standard_charge_percentage": 34.0000, "estimated_amount": 105, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 311, "estimated_amount": 311, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 85.53, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 85, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 311, "estimated_amount": 311, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 93.3, "standard_charge_percentage": 30.0000, "estimated_amount": 93, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 248.8, "standard_charge_percentage": 80.0000, "estimated_amount": 248, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 238.19, "estimated_amount": 238, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 220.81, "standard_charge_percentage": 71.0000, "estimated_amount": 220, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 248.8, "standard_charge_percentage": 80.0000, "estimated_amount": 248, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 311, "estimated_amount": 311, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 130.62, "estimated_amount": 130, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 248.8, "standard_charge_percentage": 80.0000, "estimated_amount": 248, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 289.97, "estimated_amount": 289, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 196.76, "estimated_amount": 196, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 311, "estimated_amount": 311, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 311, "estimated_amount": 311, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 227.83, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 233.25, "standard_charge_percentage": 75.0000, "estimated_amount": 233, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 311, "estimated_amount": 311, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 68.11, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 68, "methodology": "percent of total billed charges" }]}]} , { "description": "I&d abscess compmultiple", "code_information": [ { "code": "10061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 603, "discounted_cash": 541,"minimum": 120.6,"maximum": 603,"payers_information":[{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 413.06, "estimated_amount": 413, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 120.6, "standard_charge_percentage": 20.0000, "estimated_amount": 120, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 132.06, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 132, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 221.49, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 603, "estimated_amount": 603, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 422.1, "standard_charge_percentage": 70.0000, "estimated_amount": 422, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 500.49, "standard_charge_percentage": 83.0000, "estimated_amount": 500, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 603, "estimated_amount": 603, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 603, "estimated_amount": 603, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 391.95, "standard_charge_percentage": 65.0000, "estimated_amount": 391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 421.94, "estimated_amount": 421, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 180.9, "standard_charge_percentage": 30.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 603, "estimated_amount": 603, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 482.4, "standard_charge_percentage": 80.0000, "estimated_amount": 482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 603, "estimated_amount": 603, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 603, "estimated_amount": 603, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 603, "estimated_amount": 603, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 132.06, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 132, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 452.25, "standard_charge_percentage": 75.0000, "estimated_amount": 452, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 482.4, "standard_charge_percentage": 80.0000, "estimated_amount": 482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 205.02, "standard_charge_percentage": 34.0000, "estimated_amount": 205, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 428.13, "standard_charge_percentage": 71.0000, "estimated_amount": 428, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 221.49, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 482.4, "standard_charge_percentage": 80.0000, "estimated_amount": 482, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 157.38, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 444.15, "estimated_amount": 444, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 165.82, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 165, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 192.96, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 482.4, "standard_charge_percentage": 80.0000, "estimated_amount": 482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 482.4, "standard_charge_percentage": 80.0000, "estimated_amount": 482, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 132.06, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 132, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" }]}]} , { "description": "I&d pilonidal cyst simple", "code_information": [ { "code": "10080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1110, "discounted_cash": 953,"minimum": 207.32,"maximum": 1110,"payers_information":[{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 249.68, "estimated_amount": 249, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 413.06, "estimated_amount": 413, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 249.68, "estimated_amount": 249, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 305.25, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 777, "standard_charge_percentage": 70.0000, "estimated_amount": 777, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1110, "estimated_amount": 1110, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 277.5, "standard_charge_percentage": 25.0000, "estimated_amount": 277, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 243.09, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 243, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1110, "estimated_amount": 1110, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 888, "standard_charge_percentage": 80.0000, "estimated_amount": 888, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1110, "estimated_amount": 1110, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 243.09, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 243, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 333, "standard_charge_percentage": 30.0000, "estimated_amount": 333, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 289.71, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 243.09, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 243, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 788.1, "standard_charge_percentage": 71.0000, "estimated_amount": 788, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 888, "standard_charge_percentage": 80.0000, "estimated_amount": 888, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 888, "standard_charge_percentage": 80.0000, "estimated_amount": 888, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1110, "estimated_amount": 1110, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 921.3, "standard_charge_percentage": 83.0000, "estimated_amount": 921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1110, "estimated_amount": 1110, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 421.94, "estimated_amount": 421, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 721.5, "standard_charge_percentage": 65.0000, "estimated_amount": 721, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 222, "standard_charge_percentage": 20.0000, "estimated_amount": 222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 377.4, "standard_charge_percentage": 34.0000, "estimated_amount": 377, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 888, "standard_charge_percentage": 80.0000, "estimated_amount": 888, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 832.5, "standard_charge_percentage": 75.0000, "estimated_amount": 832, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 888, "standard_charge_percentage": 80.0000, "estimated_amount": 888, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 444.15, "estimated_amount": 444, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 355.2, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 355, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1110, "estimated_amount": 1110, "methodology": "case rate" }]}]} , { "description": "Inc&rmvl fb subq tiss smpl", "code_information": [ { "code": "10120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1045, "discounted_cash": 541,"minimum": 154.76,"maximum": 8356.44,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 154.76, "estimated_amount": 154, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3221.76, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 3221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 154.76, "estimated_amount": 154, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 836, "standard_charge_percentage": 80.0000, "estimated_amount": 836, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 421.94, "estimated_amount": 421, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 444.15, "estimated_amount": 444, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 783.75, "standard_charge_percentage": 75.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 731.5, "standard_charge_percentage": 70.0000, "estimated_amount": 731, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 8356.44, "standard_charge_percentage": 83.0000, "estimated_amount": 8356, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 287.38, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 287, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 7551, "standard_charge_percentage": 75.0000, "estimated_amount": 7551, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 836, "standard_charge_percentage": 80.0000, "estimated_amount": 836, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7047.6, "standard_charge_percentage": 70.0000, "estimated_amount": 7047, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 413.06, "estimated_amount": 413, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 272.75, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 272, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 741.95, "standard_charge_percentage": 71.0000, "estimated_amount": 741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 209, "standard_charge_percentage": 20.0000, "estimated_amount": 209, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 261.25, "standard_charge_percentage": 25.0000, "estimated_amount": 261, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 674.68, "estimated_amount": 674, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2768.7, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2768, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2013.6, "standard_charge_percentage": 20.0000, "estimated_amount": 2013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1045, "estimated_amount": 1045, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2204.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 444.15, "estimated_amount": 444, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2627.75, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2627, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 421.94, "estimated_amount": 421, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 228.85, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 949.88, "estimated_amount": 949, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 313.5, "standard_charge_percentage": 30.0000, "estimated_amount": 313, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2204.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3423.12, "standard_charge_percentage": 34.0000, "estimated_amount": 3423, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 836, "standard_charge_percentage": 80.0000, "estimated_amount": 836, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 228.85, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7148.28, "standard_charge_percentage": 71.0000, "estimated_amount": 7148, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 334.4, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 334, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 836, "standard_charge_percentage": 80.0000, "estimated_amount": 836, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 674.68, "estimated_amount": 674, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 6544.2, "standard_charge_percentage": 65.0000, "estimated_amount": 6544, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3020.4, "standard_charge_percentage": 30.0000, "estimated_amount": 3020, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 867.35, "standard_charge_percentage": 83.0000, "estimated_amount": 867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 2517, "standard_charge_percentage": 25.0000, "estimated_amount": 2517, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 949.88, "estimated_amount": 949, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1045, "estimated_amount": 1045, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2204.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2204, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 228.85, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 836, "standard_charge_percentage": 80.0000, "estimated_amount": 836, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 154.76, "estimated_amount": 154, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 413.06, "estimated_amount": 413, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 154.76, "estimated_amount": 154, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 679.25, "standard_charge_percentage": 65.0000, "estimated_amount": 679, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 355.3, "standard_charge_percentage": 34.0000, "estimated_amount": 355, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" }]}]} , { "description": "Inc&rmvl fb subq tiss comp", "code_information": [ { "code": "10121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3250, "discounted_cash": 2195,"minimum": 274.2,"maximum": 3250,"payers_information":[{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2600, "standard_charge_percentage": 80.0000, "estimated_amount": 2600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 893.75, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 893, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 2600, "standard_charge_percentage": 80.0000, "estimated_amount": 2600, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3250, "estimated_amount": 3250, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3250, "estimated_amount": 3250, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1105, "standard_charge_percentage": 34.0000, "estimated_amount": 1105, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 274.2, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2600, "standard_charge_percentage": 80.0000, "estimated_amount": 2600, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 848.25, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2307.5, "standard_charge_percentage": 71.0000, "estimated_amount": 2307, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 2437.5, "standard_charge_percentage": 75.0000, "estimated_amount": 2437, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2112.5, "standard_charge_percentage": 65.0000, "estimated_amount": 2112, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 2600, "standard_charge_percentage": 80.0000, "estimated_amount": 2600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 650, "standard_charge_percentage": 20.0000, "estimated_amount": 650, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3250, "estimated_amount": 3250, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 3250, "estimated_amount": 3250, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 2600, "standard_charge_percentage": 80.0000, "estimated_amount": 2600, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 274.2, "estimated_amount": 274, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 711.75, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 711, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 2697.5, "standard_charge_percentage": 83.0000, "estimated_amount": 2697, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2275, "standard_charge_percentage": 70.0000, "estimated_amount": 2275, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 3250, "estimated_amount": 3250, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 711.75, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 975, "standard_charge_percentage": 30.0000, "estimated_amount": 975, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 711.75, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" }]}]} , { "description": "I&R FOREIGN BDY SUBQ TISS SMPL", "code_information": [ { "code": "10140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2616, "discounted_cash": 2195,"minimum": 174.37,"maximum": 2616,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 719.4, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 719, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 2092.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2092, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2616, "estimated_amount": 2616, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 174.37, "estimated_amount": 174, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1347.12, "estimated_amount": 1347, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 2616, "estimated_amount": 2616, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1831.2, "standard_charge_percentage": 70.0000, "estimated_amount": 1831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2616, "estimated_amount": 2616, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1347.12, "estimated_amount": 1347, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1700.4, "standard_charge_percentage": 65.0000, "estimated_amount": 1700, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2092.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2092, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2092.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2092, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1347.12, "estimated_amount": 1347, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 2616, "estimated_amount": 2616, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1347.12, "estimated_amount": 1347, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 174.37, "estimated_amount": 174, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1962, "standard_charge_percentage": 75.0000, "estimated_amount": 1962, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1347.12, "estimated_amount": 1347, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 572.9, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 572, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 2616, "estimated_amount": 2616, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 654, "standard_charge_percentage": 25.0000, "estimated_amount": 654, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 2616, "estimated_amount": 2616, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 2171.28, "standard_charge_percentage": 83.0000, "estimated_amount": 2171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1414.48, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1857.36, "standard_charge_percentage": 71.0000, "estimated_amount": 1857, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 2092.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2092, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 572.9, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 572, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 889.44, "standard_charge_percentage": 34.0000, "estimated_amount": 889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1347.12, "estimated_amount": 1347, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 682.78, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 837.12, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 784.8, "standard_charge_percentage": 30.0000, "estimated_amount": 784, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 523.2, "standard_charge_percentage": 20.0000, "estimated_amount": 523, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2616, "estimated_amount": 2616, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 572.9, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 572, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2616, "estimated_amount": 2616, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1414.48, "estimated_amount": 1414, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 2092.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2092, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" }]}]} , { "description": "EXC BEN LES SC/NK/H/F0.6-1.0CM", "code_information": [ { "code": "10160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 603, "discounted_cash": 541,"minimum": 120.6,"maximum": 603,"payers_information":[{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 452.25, "standard_charge_percentage": 75.0000, "estimated_amount": 452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 120.6, "standard_charge_percentage": 20.0000, "estimated_amount": 120, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 428.13, "standard_charge_percentage": 71.0000, "estimated_amount": 428, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 482.4, "standard_charge_percentage": 80.0000, "estimated_amount": 482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 603, "estimated_amount": 603, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 205.02, "standard_charge_percentage": 34.0000, "estimated_amount": 205, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 192.96, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 603, "estimated_amount": 603, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 316.61, "estimated_amount": 316, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 603, "estimated_amount": 603, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 300.78, "estimated_amount": 300, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 603, "estimated_amount": 603, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 422.1, "standard_charge_percentage": 70.0000, "estimated_amount": 422, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 500.49, "standard_charge_percentage": 83.0000, "estimated_amount": 500, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 180.9, "standard_charge_percentage": 30.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 391.95, "standard_charge_percentage": 65.0000, "estimated_amount": 391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 132.06, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 132, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 482.4, "standard_charge_percentage": 80.0000, "estimated_amount": 482, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 133.89, "estimated_amount": 133, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 294.45, "estimated_amount": 294, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 150.75, "standard_charge_percentage": 25.0000, "estimated_amount": 150, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 482.4, "standard_charge_percentage": 80.0000, "estimated_amount": 482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 482.4, "standard_charge_percentage": 80.0000, "estimated_amount": 482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 603, "estimated_amount": 603, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 482.4, "standard_charge_percentage": 80.0000, "estimated_amount": 482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 132.06, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 132, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 165.82, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 165, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 132.06, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 132, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 157.38, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 157, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 603, "estimated_amount": 603, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 133.89, "estimated_amount": 133, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 603, "estimated_amount": 603, "methodology": "case rate" }]}]} , { "description": "I&d complex po wound infctj", "code_information": [ { "code": "10180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8528, "discounted_cash": 3878,"minimum": 277.29,"maximum": 7078.24,"payers_information":[{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5543.2, "standard_charge_percentage": 65.0000, "estimated_amount": 5543, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 277.29, "estimated_amount": 277, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6396, "standard_charge_percentage": 75.0000, "estimated_amount": 6396, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2225.81, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2225, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6054.88, "standard_charge_percentage": 71.0000, "estimated_amount": 6054, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5133.26, "estimated_amount": 5133, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5025.19, "estimated_amount": 5025, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 277.29, "estimated_amount": 277, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1339.11, "estimated_amount": 1339, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2558.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2558, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1705.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5969.6, "standard_charge_percentage": 70.0000, "estimated_amount": 5969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2899.52, "standard_charge_percentage": 34.0000, "estimated_amount": 2899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1339.11, "estimated_amount": 1339, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7078.24, "standard_charge_percentage": 83.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2345.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2345, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 5403.43, "estimated_amount": 5403, "methodology": "case rate" }]}]} , { "description": "UNLISTED PROC NERVOUS SYSTEM", "code_information": [ { "code": "11001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 258,"minimum": 27.61,"maximum": 258,"payers_information":[{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 127.65, "standard_charge_percentage": 53.2000, "estimated_amount": 127, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 206.4, "standard_charge_percentage": 80.0000, "estimated_amount": 206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 258, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 258, "estimated_amount": 258, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 27.61, "estimated_amount": 27, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 258, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 258, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 193.5, "standard_charge_percentage": 75.0000, "estimated_amount": 193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 258, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.34, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 67, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 56.5, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 56, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 206.4, "standard_charge_percentage": 80.0000, "estimated_amount": 206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 51.6, "standard_charge_percentage": 20.0000, "estimated_amount": 51, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 56.5, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 56, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 214.14, "standard_charge_percentage": 83.0000, "estimated_amount": 214, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 130.39, "standard_charge_percentage": 53.2000, "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 206.4, "standard_charge_percentage": 80.0000, "estimated_amount": 206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 27.61, "estimated_amount": 27, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 258, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 258, "estimated_amount": 258, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 167.7, "standard_charge_percentage": 65.0000, "estimated_amount": 167, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 258, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 77.4, "standard_charge_percentage": 30.0000, "estimated_amount": 77, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 206.4, "standard_charge_percentage": 80.0000, "estimated_amount": 206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 64.5, "standard_charge_percentage": 25.0000, "estimated_amount": 64, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 56.5, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 56, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 87.72, "standard_charge_percentage": 34.0000, "estimated_amount": 87, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 258, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 258, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 82.56, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 82, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 70.95, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 70, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 180.6, "standard_charge_percentage": 70.0000, "estimated_amount": 180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 137.26, "standard_charge_percentage": 53.2000, "estimated_amount": 137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 206.4, "standard_charge_percentage": 80.0000, "estimated_amount": 206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 183.18, "standard_charge_percentage": 71.0000, "estimated_amount": 183, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "11012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5034, "discounted_cash": 3878,"minimum": 488,"maximum": 5034,"payers_information":[{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1262.82, "estimated_amount": 1262, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 679.57, "estimated_amount": 679, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4027.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3775.5, "standard_charge_percentage": 75.0000, "estimated_amount": 3775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1711.56, "standard_charge_percentage": 34.0000, "estimated_amount": 1711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1174.42, "estimated_amount": 1174, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4027.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4027, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3272.1, "standard_charge_percentage": 65.0000, "estimated_amount": 3272, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1384.35, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 4178.22, "standard_charge_percentage": 83.0000, "estimated_amount": 4178, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1006.8, "standard_charge_percentage": 20.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3523.8, "standard_charge_percentage": 70.0000, "estimated_amount": 3523, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4027.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 679.57, "estimated_amount": 679, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1102.45, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1313.87, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1313, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1102.45, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1339.11, "estimated_amount": 1339, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4027.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3574.14, "standard_charge_percentage": 71.0000, "estimated_amount": 3574, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1510.2, "standard_charge_percentage": 30.0000, "estimated_amount": 1510, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4027.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1199.68, "estimated_amount": 1199, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1102.45, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1339.11, "estimated_amount": 1339, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" }]}]} , { "description": "Dbrdmt subq tis 1st 20sqcm/<", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7172, "discounted_cash": 541,"minimum": 131.72,"maximum": 5952.76,"payers_information":[{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5737.6, "standard_charge_percentage": 80.0000, "estimated_amount": 5737, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 673.5, "standard_charge_percentage": 30.0000, "estimated_amount": 673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 1863.35, "standard_charge_percentage": 83.0000, "estimated_amount": 1863, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 131.72, "estimated_amount": 131, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2151.6, "standard_charge_percentage": 30.0000, "estimated_amount": 2151, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5737.6, "standard_charge_percentage": 80.0000, "estimated_amount": 5737, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 674.68, "estimated_amount": 674, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1796, "standard_charge_percentage": 80.0000, "estimated_amount": 1796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 131.72, "estimated_amount": 131, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 949.88, "estimated_amount": 949, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5020.4, "standard_charge_percentage": 70.0000, "estimated_amount": 5020, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 617.38, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 617, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 491.65, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 767.73, "estimated_amount": 767, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 784.24, "estimated_amount": 784, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1796, "standard_charge_percentage": 80.0000, "estimated_amount": 1796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 825.52, "estimated_amount": 825, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 585.95, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 585, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2438.48, "standard_charge_percentage": 34.0000, "estimated_amount": 2438, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1571.5, "standard_charge_percentage": 70.0000, "estimated_amount": 1571, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1683.75, "standard_charge_percentage": 75.0000, "estimated_amount": 1683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4661.8, "standard_charge_percentage": 65.0000, "estimated_amount": 4661, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1459.25, "standard_charge_percentage": 65.0000, "estimated_amount": 1459, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 131.72, "estimated_amount": 131, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5737.6, "standard_charge_percentage": 80.0000, "estimated_amount": 5737, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5952.76, "standard_charge_percentage": 83.0000, "estimated_amount": 5952, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 491.65, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5737.6, "standard_charge_percentage": 80.0000, "estimated_amount": 5737, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 784.24, "estimated_amount": 784, "methodology": "case rate" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1796, "standard_charge_percentage": 80.0000, "estimated_amount": 1796, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1796, "standard_charge_percentage": 80.0000, "estimated_amount": 1796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 949.88, "estimated_amount": 949, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1796, "standard_charge_percentage": 80.0000, "estimated_amount": 1796, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5379, "standard_charge_percentage": 75.0000, "estimated_amount": 5379, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 767.73, "estimated_amount": 767, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 825.52, "estimated_amount": 825, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5737.6, "standard_charge_percentage": 80.0000, "estimated_amount": 5737, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1871.89, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1871, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 674.68, "estimated_amount": 674, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1434.4, "standard_charge_percentage": 20.0000, "estimated_amount": 1434, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1570.67, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 449, "standard_charge_percentage": 20.0000, "estimated_amount": 449, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 131.72, "estimated_amount": 131, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1570.67, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 763.3, "standard_charge_percentage": 34.0000, "estimated_amount": 763, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 5092.12, "standard_charge_percentage": 71.0000, "estimated_amount": 5092, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 491.65, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1570.67, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 2245, "estimated_amount": 2245, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1972.3, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1972, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1593.95, "standard_charge_percentage": 71.0000, "estimated_amount": 1593, "methodology": "percent of total billed charges" }]}]} , { "description": "Dbrdmt musc&fsca 1st 20<", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35811, "discounted_cash": 829,"minimum": 242.76,"maximum": 29723.1,"payers_information":[{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 25067.7, "standard_charge_percentage": 70.0000, "estimated_amount": 25067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 29723.1, "standard_charge_percentage": 83.0000, "estimated_amount": 29723, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 625.33, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 242.76, "estimated_amount": 242, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 28648.8, "standard_charge_percentage": 80.0000, "estimated_amount": 28648, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 893.33, "estimated_amount": 893, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1455.36, "estimated_amount": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 767.73, "estimated_amount": 767, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 825.52, "estimated_amount": 825, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 12175.7, "standard_charge_percentage": 34.0000, "estimated_amount": 12175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 26858.3, "standard_charge_percentage": 75.0000, "estimated_amount": 26858, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 7162.2, "standard_charge_percentage": 20.0000, "estimated_amount": 7162, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 28648.8, "standard_charge_percentage": 80.0000, "estimated_amount": 28648, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 989.04, "estimated_amount": 989, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 861.42, "estimated_amount": 861, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 733.8, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 242.76, "estimated_amount": 242, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 606.19, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 701.9, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 765.71, "estimated_amount": 765, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1033.71, "estimated_amount": 1033, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 989.04, "estimated_amount": 989, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8889, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8889, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 797.61, "estimated_amount": 797, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 784.24, "estimated_amount": 784, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 28648.8, "standard_charge_percentage": 80.0000, "estimated_amount": 28648, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 28648.8, "standard_charge_percentage": 80.0000, "estimated_amount": 28648, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 28648.8, "standard_charge_percentage": 80.0000, "estimated_amount": 28648, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 25425.8, "standard_charge_percentage": 71.0000, "estimated_amount": 25425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 23277.2, "standard_charge_percentage": 65.0000, "estimated_amount": 23277, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10743.3, "standard_charge_percentage": 30.0000, "estimated_amount": 10743, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 957.13, "estimated_amount": 957, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" }]}]} , { "description": "Dbrdmt bone 1st 20 sq cm/<", "code_information": [ { "code": "11044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14018, "discounted_cash": 2195,"minimum": 326.55,"maximum": 11634.9,"payers_information":[{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2124.3, "estimated_amount": 2124, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3069.94, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3069, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4205.4, "standard_charge_percentage": 30.0000, "estimated_amount": 4205, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 326.55, "estimated_amount": 326, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 2018.09, "estimated_amount": 2018, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 11214.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11214, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 10513.5, "standard_charge_percentage": 75.0000, "estimated_amount": 10513, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4766.12, "standard_charge_percentage": 34.0000, "estimated_amount": 4766, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9111.7, "standard_charge_percentage": 65.0000, "estimated_amount": 9111, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9812.6, "standard_charge_percentage": 70.0000, "estimated_amount": 9812, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3069.94, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3069, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11214.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11214, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1975.6, "estimated_amount": 1975, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3658.7, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3658, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 11634.9, "standard_charge_percentage": 83.0000, "estimated_amount": 11634, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 11214.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11214, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1339.11, "estimated_amount": 1339, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11214.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11214, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9952.78, "standard_charge_percentage": 71.0000, "estimated_amount": 9952, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 11214.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11214, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3854.95, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3854, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2803.6, "standard_charge_percentage": 20.0000, "estimated_amount": 2803, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1339.11, "estimated_amount": 1339, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3069.94, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3069, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 326.55, "estimated_amount": 326, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" }]}]} , { "description": "DECLOT PORT W/ THROMB AGNT", "code_information": [ { "code": "11045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1397,"minimum": 41.37,"maximum": 1397,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 305.94, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1047.75, "standard_charge_percentage": 75.0000, "estimated_amount": 1047, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 41.37, "estimated_amount": 41, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1339.11, "estimated_amount": 1339, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 279.4, "standard_charge_percentage": 20.0000, "estimated_amount": 279, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1117.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1117, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 743.2, "standard_charge_percentage": 53.2000, "estimated_amount": 743, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 1159.51, "standard_charge_percentage": 83.0000, "estimated_amount": 1159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 474.98, "standard_charge_percentage": 34.0000, "estimated_amount": 474, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 349.25, "standard_charge_percentage": 25.0000, "estimated_amount": 349, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 908.05, "standard_charge_percentage": 65.0000, "estimated_amount": 908, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 41.37, "estimated_amount": 41, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1117.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1117, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 706.04, "standard_charge_percentage": 53.2000, "estimated_amount": 706, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 691.18, "standard_charge_percentage": 53.2000, "estimated_amount": 691, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1117.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1117, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1397, "estimated_amount": 1397, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 305.94, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 305, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 447.04, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 419.1, "standard_charge_percentage": 30.0000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 364.62, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1117.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1117, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1117.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1117, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 305.94, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 305, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 384.18, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 991.87, "standard_charge_percentage": 71.0000, "estimated_amount": 991, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 977.9, "standard_charge_percentage": 70.0000, "estimated_amount": 977, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1339.11, "estimated_amount": 1339, "methodology": "fee schedule" }]}]} , { "description": "Dbrdmt bone each addl", "code_information": [ { "code": "11047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2842.68,"minimum": 130.45,"maximum": 2842.68,"payers_information":[{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 622.55, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 622, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1339.11, "estimated_amount": 1339, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1436.69, "standard_charge_percentage": 53.2000, "estimated_amount": 1436, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 2842.68, "estimated_amount": 2842, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1406.44, "standard_charge_percentage": 53.2000, "estimated_amount": 1406, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2274.14, "standard_charge_percentage": 80.0000, "estimated_amount": 2274, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 852.8, "standard_charge_percentage": 30.0000, "estimated_amount": 852, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 622.55, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 622, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 781.74, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 781, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1339.11, "estimated_amount": 1339, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 710.67, "standard_charge_percentage": 25.0000, "estimated_amount": 710, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1989.88, "standard_charge_percentage": 70.0000, "estimated_amount": 1989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 2132.01, "standard_charge_percentage": 75.0000, "estimated_amount": 2132, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 741.94, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 741, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 130.45, "estimated_amount": 130, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 130.45, "estimated_amount": 130, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1847.74, "standard_charge_percentage": 65.0000, "estimated_amount": 1847, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 909.66, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 909, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 966.51, "standard_charge_percentage": 34.0000, "estimated_amount": 966, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2274.14, "standard_charge_percentage": 80.0000, "estimated_amount": 2274, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2018.3, "standard_charge_percentage": 71.0000, "estimated_amount": 2018, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 568.54, "standard_charge_percentage": 20.0000, "estimated_amount": 568, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 2359.42, "standard_charge_percentage": 83.0000, "estimated_amount": 2359, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 2274.14, "standard_charge_percentage": 80.0000, "estimated_amount": 2274, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1512.31, "standard_charge_percentage": 53.2000, "estimated_amount": 1512, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 2274.14, "standard_charge_percentage": 80.0000, "estimated_amount": 2274, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 622.55, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 622, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 2274.14, "standard_charge_percentage": 80.0000, "estimated_amount": 2274, "methodology": "percent of total billed charges" }]}]} , { "description": "Punch bx skin single lesion", "code_information": [ { "code": "11104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 994, "discounted_cash": 541,"minimum": 124.89,"maximum": 994,"payers_information":[{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 795.2, "standard_charge_percentage": 80.0000, "estimated_amount": 795, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 825.02, "standard_charge_percentage": 83.0000, "estimated_amount": 825, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 259.43, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 259, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 217.69, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 217, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 273.35, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 273, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 745.5, "standard_charge_percentage": 75.0000, "estimated_amount": 745, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 124.89, "estimated_amount": 124, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 994, "estimated_amount": 994, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 248.5, "standard_charge_percentage": 25.0000, "estimated_amount": 248, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 198.8, "standard_charge_percentage": 20.0000, "estimated_amount": 198, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 298.2, "standard_charge_percentage": 30.0000, "estimated_amount": 298, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 646.1, "standard_charge_percentage": 65.0000, "estimated_amount": 646, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 217.69, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 217, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 705.74, "standard_charge_percentage": 71.0000, "estimated_amount": 705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 318.08, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 318, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 795.2, "standard_charge_percentage": 80.0000, "estimated_amount": 795, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 491.79, "standard_charge_percentage": 53.2000, "estimated_amount": 491, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 795.2, "standard_charge_percentage": 80.0000, "estimated_amount": 795, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 695.8, "standard_charge_percentage": 70.0000, "estimated_amount": 695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 124.89, "estimated_amount": 124, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 502.37, "standard_charge_percentage": 53.2000, "estimated_amount": 502, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 337.96, "standard_charge_percentage": 34.0000, "estimated_amount": 337, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 994, "estimated_amount": 994, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 528.81, "standard_charge_percentage": 53.2000, "estimated_amount": 528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 795.2, "standard_charge_percentage": 80.0000, "estimated_amount": 795, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 217.69, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 217, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 795.2, "standard_charge_percentage": 80.0000, "estimated_amount": 795, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 949.88, "estimated_amount": 949, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 674.68, "estimated_amount": 674, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "11106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1035, "discounted_cash": 829,"minimum": 155.55,"maximum": 1035,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 226.66, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 523.09, "standard_charge_percentage": 53.2000, "estimated_amount": 523, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 606.19, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 733.8, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 724.5, "standard_charge_percentage": 70.0000, "estimated_amount": 724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 828, "standard_charge_percentage": 80.0000, "estimated_amount": 828, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 734.85, "standard_charge_percentage": 71.0000, "estimated_amount": 734, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 957.13, "estimated_amount": 957, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 828, "standard_charge_percentage": 80.0000, "estimated_amount": 828, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 828, "standard_charge_percentage": 80.0000, "estimated_amount": 828, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 207, "standard_charge_percentage": 20.0000, "estimated_amount": 207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 672.75, "standard_charge_percentage": 65.0000, "estimated_amount": 672, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 155.55, "estimated_amount": 155, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 155.55, "estimated_amount": 155, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 765.71, "estimated_amount": 765, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 893.33, "estimated_amount": 893, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 550.62, "standard_charge_percentage": 53.2000, "estimated_amount": 550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 989.04, "estimated_amount": 989, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 284.63, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 284, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 828, "standard_charge_percentage": 80.0000, "estimated_amount": 828, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 310.5, "standard_charge_percentage": 30.0000, "estimated_amount": 310, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 351.9, "standard_charge_percentage": 34.0000, "estimated_amount": 351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 701.9, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 797.61, "estimated_amount": 797, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 861.42, "estimated_amount": 861, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 512.08, "standard_charge_percentage": 53.2000, "estimated_amount": 512, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 859.05, "standard_charge_percentage": 83.0000, "estimated_amount": 859, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 226.66, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 989.04, "estimated_amount": 989, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 776.25, "standard_charge_percentage": 75.0000, "estimated_amount": 776, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1033.71, "estimated_amount": 1033, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 226.66, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 828, "standard_charge_percentage": 80.0000, "estimated_amount": 828, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 258.75, "standard_charge_percentage": 25.0000, "estimated_amount": 258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 625.33, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 331.2, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 331, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 270.13, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 270, "methodology": "percent of total billed charges" }]}]} , { "description": "Rmvl skin tags up to&inc 15", "code_information": [ { "code": "11200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15693.6, "discounted_cash": 269,"minimum": 94.47,"maximum": 13025.7,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12554.9, "standard_charge_percentage": 80.0000, "estimated_amount": 12554, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3436.9, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3436, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 279.61, "estimated_amount": 279, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 11142.5, "standard_charge_percentage": 71.0000, "estimated_amount": 11142, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 472.4, "estimated_amount": 472, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 5021.96, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 5021, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4708.09, "standard_charge_percentage": 30.0000, "estimated_amount": 4708, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12554.9, "standard_charge_percentage": 80.0000, "estimated_amount": 12554, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 289.97, "estimated_amount": 289, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4315.75, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4315, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 94.47, "estimated_amount": 94, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3436.9, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3436, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 7764.58, "standard_charge_percentage": 53.2000, "estimated_amount": 7764, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4096.03, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4096, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 13025.7, "standard_charge_percentage": 83.0000, "estimated_amount": 13025, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 227.83, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 3923.41, "standard_charge_percentage": 25.0000, "estimated_amount": 3923, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 196.76, "estimated_amount": 196, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 12554.9, "standard_charge_percentage": 80.0000, "estimated_amount": 12554, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 10200.9, "standard_charge_percentage": 65.0000, "estimated_amount": 10200, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7931.56, "standard_charge_percentage": 53.2000, "estimated_amount": 7931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 202.98, "estimated_amount": 202, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 11770.2, "standard_charge_percentage": 75.0000, "estimated_amount": 11770, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 310.68, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 94.47, "estimated_amount": 94, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 248.54, "estimated_amount": 248, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 258.9, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3138.72, "standard_charge_percentage": 20.0000, "estimated_amount": 3138, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5335.83, "standard_charge_percentage": 34.0000, "estimated_amount": 5335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 12554.9, "standard_charge_percentage": 80.0000, "estimated_amount": 12554, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 238.19, "estimated_amount": 238, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 12554.9, "standard_charge_percentage": 80.0000, "estimated_amount": 12554, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 10985.5, "standard_charge_percentage": 70.0000, "estimated_amount": 10985, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3436.9, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3436, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 8349.01, "standard_charge_percentage": 53.2000, "estimated_amount": 8349, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 335.53, "estimated_amount": 335, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "11301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12646, "discounted_cash": 269,"minimum": 121.55,"maximum": 10496.2,"payers_information":[{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2529.2, "standard_charge_percentage": 20.0000, "estimated_amount": 2529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 6108.02, "standard_charge_percentage": 48.3000, "estimated_amount": 6108, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9484.5, "standard_charge_percentage": 75.0000, "estimated_amount": 9484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10116.8, "standard_charge_percentage": 80.0000, "estimated_amount": 10116, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3300.61, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3300, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10116.8, "standard_charge_percentage": 80.0000, "estimated_amount": 10116, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2769.47, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2769, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 227.83, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3477.65, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3477, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 121.55, "estimated_amount": 121, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 248.54, "estimated_amount": 248, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 472.4, "estimated_amount": 472, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10116.8, "standard_charge_percentage": 80.0000, "estimated_amount": 10116, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 6256.73, "standard_charge_percentage": 53.2000, "estimated_amount": 6256, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6391.29, "standard_charge_percentage": 53.2000, "estimated_amount": 6391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 335.53, "estimated_amount": 335, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 8978.66, "standard_charge_percentage": 71.0000, "estimated_amount": 8978, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4046.72, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 4046, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 3161.5, "standard_charge_percentage": 25.0000, "estimated_amount": 3161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 289.97, "estimated_amount": 289, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 238.19, "estimated_amount": 238, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 121.55, "estimated_amount": 121, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2769.47, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2769, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2769.47, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2769, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10116.8, "standard_charge_percentage": 80.0000, "estimated_amount": 10116, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 279.61, "estimated_amount": 279, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 202.98, "estimated_amount": 202, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10116.8, "standard_charge_percentage": 80.0000, "estimated_amount": 10116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 310.68, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8219.9, "standard_charge_percentage": 65.0000, "estimated_amount": 8219, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6727.67, "standard_charge_percentage": 53.2000, "estimated_amount": 6727, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10496.2, "standard_charge_percentage": 83.0000, "estimated_amount": 10496, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 8852.2, "standard_charge_percentage": 70.0000, "estimated_amount": 8852, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 258.9, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3793.8, "standard_charge_percentage": 30.0000, "estimated_amount": 3793, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4299.64, "standard_charge_percentage": 34.0000, "estimated_amount": 4299, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 196.76, "estimated_amount": 196, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "11400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9032.5, "discounted_cash": 953,"minimum": 130.79,"maximum": 7496.98,"payers_information":[{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6413.07, "standard_charge_percentage": 71.0000, "estimated_amount": 6413, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6774.38, "standard_charge_percentage": 75.0000, "estimated_amount": 6774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1262.82, "estimated_amount": 1262, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7226, "standard_charge_percentage": 80.0000, "estimated_amount": 7226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7226, "standard_charge_percentage": 80.0000, "estimated_amount": 7226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5871.13, "standard_charge_percentage": 65.0000, "estimated_amount": 5871, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1978.12, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1199.68, "estimated_amount": 1199, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 130.79, "estimated_amount": 130, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2709.75, "standard_charge_percentage": 30.0000, "estimated_amount": 2709, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7496.98, "standard_charge_percentage": 83.0000, "estimated_amount": 7496, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2483.94, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2483, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2357.48, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2357, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3071.05, "standard_charge_percentage": 34.0000, "estimated_amount": 3071, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6322.75, "standard_charge_percentage": 70.0000, "estimated_amount": 6322, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 7226, "standard_charge_percentage": 80.0000, "estimated_amount": 7226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2890.4, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2890, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1188.16, "estimated_amount": 1188, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1978.12, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 130.79, "estimated_amount": 130, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1978.12, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1978, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1806.5, "standard_charge_percentage": 20.0000, "estimated_amount": 1806, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1174.42, "estimated_amount": 1174, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 7226, "standard_charge_percentage": 80.0000, "estimated_amount": 7226, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1672.81, "estimated_amount": 1672, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 7226, "standard_charge_percentage": 80.0000, "estimated_amount": 7226, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" }]}]} , { "description": "Exc tr-ext b9+marg 0.6-1 cm", "code_information": [ { "code": "11401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2416.68, "discounted_cash": 541,"minimum": 159.02,"maximum": 2416.68,"payers_information":[{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 483.34, "standard_charge_percentage": 20.0000, "estimated_amount": 483, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 2416.68, "estimated_amount": 2416, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 159.02, "estimated_amount": 159, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 529.25, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 821.67, "standard_charge_percentage": 34.0000, "estimated_amount": 821, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1812.51, "standard_charge_percentage": 75.0000, "estimated_amount": 1812, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 529.25, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1933.34, "standard_charge_percentage": 80.0000, "estimated_amount": 1933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 674.68, "estimated_amount": 674, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 630.75, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 630, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1199.68, "estimated_amount": 1199, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1174.42, "estimated_amount": 1174, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1933.34, "standard_charge_percentage": 80.0000, "estimated_amount": 1933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 529.25, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1933.34, "standard_charge_percentage": 80.0000, "estimated_amount": 1933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1715.84, "standard_charge_percentage": 71.0000, "estimated_amount": 1715, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 949.88, "estimated_amount": 949, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1691.68, "standard_charge_percentage": 70.0000, "estimated_amount": 1691, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 2005.84, "standard_charge_percentage": 83.0000, "estimated_amount": 2005, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 773.34, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 773, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1262.82, "estimated_amount": 1262, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1933.34, "standard_charge_percentage": 80.0000, "estimated_amount": 1933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1570.84, "standard_charge_percentage": 65.0000, "estimated_amount": 1570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1933.34, "standard_charge_percentage": 80.0000, "estimated_amount": 1933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 159.02, "estimated_amount": 159, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 664.59, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 664, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 725, "standard_charge_percentage": 30.0000, "estimated_amount": 725, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "11402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5223, "discounted_cash": 953,"minimum": 175.79,"maximum": 4550,"payers_information":[{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1174.42, "estimated_amount": 1174, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3708.33, "standard_charge_percentage": 71.0000, "estimated_amount": 3708, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1671.36, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 1671, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1143.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1143, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1188.16, "estimated_amount": 1188, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1143.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1143, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4178.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4178, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4178.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4178, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 175.79, "estimated_amount": 175, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 175.79, "estimated_amount": 175, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1363.2, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1363, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1262.82, "estimated_amount": 1262, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1672.81, "estimated_amount": 1672, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3394.95, "standard_charge_percentage": 65.0000, "estimated_amount": 3394, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3917.25, "standard_charge_percentage": 75.0000, "estimated_amount": 3917, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 4335.09, "standard_charge_percentage": 83.0000, "estimated_amount": 4335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3656.1, "standard_charge_percentage": 70.0000, "estimated_amount": 3656, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1199.68, "estimated_amount": 1199, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4178.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4178, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4178.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4178, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1566.9, "standard_charge_percentage": 30.0000, "estimated_amount": 1566, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1143.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1143, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4178.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4178, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1436.33, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1436, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1775.82, "standard_charge_percentage": 34.0000, "estimated_amount": 1775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1044.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1044, "methodology": "percent of total billed charges" }]}]} , { "description": "Exc tr-ext b9+marg 2.1-3cm", "code_information": [ { "code": "11403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15111, "discounted_cash": 953,"minimum": 205.61,"maximum": 12542.1,"payers_information":[{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1996.05, "estimated_amount": 1996, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4533.3, "standard_charge_percentage": 30.0000, "estimated_amount": 4533, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3022.2, "standard_charge_percentage": 20.0000, "estimated_amount": 3022, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1672.81, "estimated_amount": 1672, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3943.97, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3943, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 10577.7, "standard_charge_percentage": 70.0000, "estimated_amount": 10577, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 10728.8, "standard_charge_percentage": 71.0000, "estimated_amount": 10728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9822.15, "standard_charge_percentage": 65.0000, "estimated_amount": 9822, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 11333.3, "standard_charge_percentage": 75.0000, "estimated_amount": 11333, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4155.52, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4835.52, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 4835, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2101.11, "estimated_amount": 2101, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1954.03, "estimated_amount": 1954, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1188.16, "estimated_amount": 1188, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 205.61, "estimated_amount": 205, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 12542.1, "standard_charge_percentage": 83.0000, "estimated_amount": 12542, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 205.61, "estimated_amount": 205, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5137.74, "standard_charge_percentage": 34.0000, "estimated_amount": 5137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" }]}]} , { "description": "Exc tr-ext b9+marg 3.1-4 cm", "code_information": [ { "code": "11404", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11097, "discounted_cash": 2195,"minimum": 234.52,"maximum": 9210.51,"payers_information":[{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7878.87, "standard_charge_percentage": 71.0000, "estimated_amount": 7878, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 8322.75, "standard_charge_percentage": 75.0000, "estimated_amount": 8322, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 234.52, "estimated_amount": 234, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3051.68, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3051, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3772.98, "standard_charge_percentage": 34.0000, "estimated_amount": 3772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2219.4, "standard_charge_percentage": 20.0000, "estimated_amount": 2219, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2896.32, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2896, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4427.78, "estimated_amount": 4427, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4660.82, "estimated_amount": 4660, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4334.56, "estimated_amount": 4334, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1442, "estimated_amount": 1442, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 9210.51, "standard_charge_percentage": 83.0000, "estimated_amount": 9210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3329.1, "standard_charge_percentage": 30.0000, "estimated_amount": 3329, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7213.05, "standard_charge_percentage": 65.0000, "estimated_amount": 7213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7767.9, "standard_charge_percentage": 70.0000, "estimated_amount": 7767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 234.52, "estimated_amount": 234, "methodology": "fee schedule" }]}]} , { "description": "Exc tr-ext b9+marg >4.0 cm", "code_information": [ { "code": "11406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13104, "discounted_cash": 2195,"minimum": 337.77,"maximum": 10876.3,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2357.12, "estimated_amount": 2357, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2357.12, "estimated_amount": 2357, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3420.14, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2620.8, "standard_charge_percentage": 20.0000, "estimated_amount": 2620, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4455.36, "standard_charge_percentage": 34.0000, "estimated_amount": 4455, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3931.2, "standard_charge_percentage": 30.0000, "estimated_amount": 3931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4660.82, "estimated_amount": 4660, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3603.6, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8517.6, "standard_charge_percentage": 65.0000, "estimated_amount": 8517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9303.84, "standard_charge_percentage": 71.0000, "estimated_amount": 9303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9828, "standard_charge_percentage": 75.0000, "estimated_amount": 9828, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10876.3, "standard_charge_percentage": 83.0000, "estimated_amount": 10876, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 337.77, "estimated_amount": 337, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9172.8, "standard_charge_percentage": 70.0000, "estimated_amount": 9172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 337.77, "estimated_amount": 337, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4427.78, "estimated_amount": 4427, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4334.56, "estimated_amount": 4334, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" }]}]} , { "description": "Exc h-f-nk-sp b9+marg 0.5/<", "code_information": [ { "code": "11420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8652, "discounted_cash": 2195,"minimum": 129.07,"maximum": 7181.16,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1894.79, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1894, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1894.79, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1894, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1730.4, "standard_charge_percentage": 20.0000, "estimated_amount": 1730, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7181.16, "standard_charge_percentage": 83.0000, "estimated_amount": 7181, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6489, "standard_charge_percentage": 75.0000, "estimated_amount": 6489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6142.92, "standard_charge_percentage": 71.0000, "estimated_amount": 6142, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6056.4, "standard_charge_percentage": 70.0000, "estimated_amount": 6056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2768.64, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2768, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1954.03, "estimated_amount": 1954, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2101.11, "estimated_amount": 2101, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2595.6, "standard_charge_percentage": 30.0000, "estimated_amount": 2595, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5623.8, "standard_charge_percentage": 65.0000, "estimated_amount": 5623, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2941.68, "standard_charge_percentage": 34.0000, "estimated_amount": 2941, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1996.05, "estimated_amount": 1996, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 129.07, "estimated_amount": 129, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2379.3, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2379, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1894.79, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1894, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 129.07, "estimated_amount": 129, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2258.17, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" }]}]} , { "description": "Exc h-f-nk-sp b9+marg 0.6-1", "code_information": [ { "code": "11421", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8528, "discounted_cash": 953,"minimum": 162.56,"maximum": 7078.24,"payers_information":[{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2899.52, "standard_charge_percentage": 34.0000, "estimated_amount": 2899, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 162.56, "estimated_amount": 162, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6396, "standard_charge_percentage": 75.0000, "estimated_amount": 6396, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1672.81, "estimated_amount": 1672, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2345.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2345, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1954.03, "estimated_amount": 1954, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2101.11, "estimated_amount": 2101, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2728.96, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1705.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6054.88, "standard_charge_percentage": 71.0000, "estimated_amount": 6054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7078.24, "standard_charge_percentage": 83.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5969.6, "standard_charge_percentage": 70.0000, "estimated_amount": 5969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5543.2, "standard_charge_percentage": 65.0000, "estimated_amount": 5543, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 162.56, "estimated_amount": 162, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2225.81, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2225, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1996.05, "estimated_amount": 1996, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2558.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2558, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1188.16, "estimated_amount": 1188, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" }]}]} , { "description": "Exc h-f-nk-sp b9+marg 1.1-2", "code_information": [ { "code": "11422", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5448, "discounted_cash": 2195,"minimum": 184.25,"maximum": 4550,"payers_information":[{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1743.36, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 1743, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1954.03, "estimated_amount": 1954, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4358.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4358, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4358.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4358, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4086, "standard_charge_percentage": 75.0000, "estimated_amount": 4086, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4358.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4358, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1996.05, "estimated_amount": 1996, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4358.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4358, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1193.11, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1193, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1193.11, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1193, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1498.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1498, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3541.2, "standard_charge_percentage": 65.0000, "estimated_amount": 3541, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 184.25, "estimated_amount": 184, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3868.08, "standard_charge_percentage": 71.0000, "estimated_amount": 3868, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3813.6, "standard_charge_percentage": 70.0000, "estimated_amount": 3813, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1421.93, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1421, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1852.32, "standard_charge_percentage": 34.0000, "estimated_amount": 1852, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 184.25, "estimated_amount": 184, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2101.11, "estimated_amount": 2101, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1193.11, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1193, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 4521.84, "standard_charge_percentage": 83.0000, "estimated_amount": 4521, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1634.4, "standard_charge_percentage": 30.0000, "estimated_amount": 1634, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4358.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4358, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1089.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1089, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" }]}]} , { "description": "Exc h-f-nk-sp b9+marg 2.1-3", "code_information": [ { "code": "11423", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8652, "discounted_cash": 2195,"minimum": 213.44,"maximum": 7181.16,"payers_information":[{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2258.17, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2258, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1894.79, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1894, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7181.16, "standard_charge_percentage": 83.0000, "estimated_amount": 7181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1730.4, "standard_charge_percentage": 20.0000, "estimated_amount": 1730, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6489, "standard_charge_percentage": 75.0000, "estimated_amount": 6489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2768.64, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2768, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1894.79, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1894, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4427.78, "estimated_amount": 4427, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 213.44, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6056.4, "standard_charge_percentage": 70.0000, "estimated_amount": 6056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5623.8, "standard_charge_percentage": 65.0000, "estimated_amount": 5623, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4660.82, "estimated_amount": 4660, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2379.3, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2379, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1894.79, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1894, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4334.56, "estimated_amount": 4334, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2595.6, "standard_charge_percentage": 30.0000, "estimated_amount": 2595, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2941.68, "standard_charge_percentage": 34.0000, "estimated_amount": 2941, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 213.44, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6142.92, "standard_charge_percentage": 71.0000, "estimated_amount": 6142, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" }]}]} , { "description": "Exc H-F-Nk-Sp B9+Marg 3.1-4", "code_information": [ { "code": "11424", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9469, "discounted_cash": 2195,"minimum": 249.52,"maximum": 7859.27,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3219.46, "standard_charge_percentage": 34.0000, "estimated_amount": 3219, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7859.27, "standard_charge_percentage": 83.0000, "estimated_amount": 7859, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2603.97, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7575.2, "standard_charge_percentage": 80.0000, "estimated_amount": 7575, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 249.52, "estimated_amount": 249, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2073.71, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2073, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4427.78, "estimated_amount": 4427, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 6154.85, "standard_charge_percentage": 65.0000, "estimated_amount": 6154, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2073.71, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2073, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2471.41, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4660.82, "estimated_amount": 4660, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7575.2, "standard_charge_percentage": 80.0000, "estimated_amount": 7575, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2073.71, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2073, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6628.3, "standard_charge_percentage": 70.0000, "estimated_amount": 6628, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2840.7, "standard_charge_percentage": 30.0000, "estimated_amount": 2840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 7575.2, "standard_charge_percentage": 80.0000, "estimated_amount": 7575, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1893.8, "standard_charge_percentage": 20.0000, "estimated_amount": 1893, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 249.52, "estimated_amount": 249, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 7101.75, "standard_charge_percentage": 75.0000, "estimated_amount": 7101, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 7575.2, "standard_charge_percentage": 80.0000, "estimated_amount": 7575, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6722.99, "standard_charge_percentage": 71.0000, "estimated_amount": 6722, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 7575.2, "standard_charge_percentage": 80.0000, "estimated_amount": 7575, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4334.56, "estimated_amount": 4334, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" }]}]} , { "description": "Exc h-f-nk-sp b9+marg >4 cm", "code_information": [ { "code": "11426", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13104, "discounted_cash": 3878,"minimum": 347.73,"maximum": 10876.3,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2357.12, "estimated_amount": 2357, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3603.6, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3931.2, "standard_charge_percentage": 30.0000, "estimated_amount": 3931, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6192.56, "estimated_amount": 6192, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2357.12, "estimated_amount": 2357, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9172.8, "standard_charge_percentage": 70.0000, "estimated_amount": 9172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 347.73, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5759.08, "estimated_amount": 5759, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 347.73, "estimated_amount": 347, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4455.36, "standard_charge_percentage": 34.0000, "estimated_amount": 4455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9303.84, "standard_charge_percentage": 71.0000, "estimated_amount": 9303, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9828, "standard_charge_percentage": 75.0000, "estimated_amount": 9828, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2620.8, "standard_charge_percentage": 20.0000, "estimated_amount": 2620, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10876.3, "standard_charge_percentage": 83.0000, "estimated_amount": 10876, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3420.14, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5882.93, "estimated_amount": 5882, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8517.6, "standard_charge_percentage": 65.0000, "estimated_amount": 8517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" }]}]} , { "description": "Exc face-mm b9+marg 0.5 cm/<", "code_information": [ { "code": "11440", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6988, "discounted_cash": 953,"minimum": 144.62,"maximum": 5800.04,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1530.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1921.7, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1530.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1530, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4961.48, "standard_charge_percentage": 71.0000, "estimated_amount": 4961, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1823.87, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4542.2, "standard_charge_percentage": 65.0000, "estimated_amount": 4542, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1530.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1397.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1397, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1672.81, "estimated_amount": 1672, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5241, "standard_charge_percentage": 75.0000, "estimated_amount": 5241, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 144.62, "estimated_amount": 144, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1174.42, "estimated_amount": 1174, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 144.62, "estimated_amount": 144, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5800.04, "standard_charge_percentage": 83.0000, "estimated_amount": 5800, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2236.16, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2236, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4891.6, "standard_charge_percentage": 70.0000, "estimated_amount": 4891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2375.92, "standard_charge_percentage": 34.0000, "estimated_amount": 2375, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2096.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2096, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1188.16, "estimated_amount": 1188, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1262.82, "estimated_amount": 1262, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1199.68, "estimated_amount": 1199, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" }]}]} , { "description": "Exc face-mm b9+marg 0.6-1 cm", "code_information": [ { "code": "11441", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14698, "discounted_cash": 953,"minimum": 177.07,"maximum": 12199.3,"payers_information":[{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1188.16, "estimated_amount": 1188, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4409.4, "standard_charge_percentage": 30.0000, "estimated_amount": 4409, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11758.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 177.07, "estimated_amount": 177, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1174.42, "estimated_amount": 1174, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 11758.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1262.82, "estimated_amount": 1262, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1199.68, "estimated_amount": 1199, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1672.81, "estimated_amount": 1672, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 177.07, "estimated_amount": 177, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 10435.6, "standard_charge_percentage": 71.0000, "estimated_amount": 10435, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4997.32, "standard_charge_percentage": 34.0000, "estimated_amount": 4997, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 12199.3, "standard_charge_percentage": 83.0000, "estimated_amount": 12199, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11758.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11758, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3836.18, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3836, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 11758.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3218.86, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2939.6, "standard_charge_percentage": 20.0000, "estimated_amount": 2939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3218.86, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4041.95, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4041, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 11023.5, "standard_charge_percentage": 75.0000, "estimated_amount": 11023, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4703.36, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 4703, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 10288.6, "standard_charge_percentage": 70.0000, "estimated_amount": 10288, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9553.7, "standard_charge_percentage": 65.0000, "estimated_amount": 9553, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 11758.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11758, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3218.86, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3218, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" }]}]} , { "description": "Exc face-mm b9+marg 1.1-2 cm", "code_information": [ { "code": "11442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11097, "discounted_cash": 953,"minimum": 198.74,"maximum": 9210.51,"payers_information":[{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7878.87, "standard_charge_percentage": 71.0000, "estimated_amount": 7878, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1188.16, "estimated_amount": 1188, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3551.04, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 3551, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2101.11, "estimated_amount": 2101, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1996.05, "estimated_amount": 1996, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1954.03, "estimated_amount": 1954, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 9210.51, "standard_charge_percentage": 83.0000, "estimated_amount": 9210, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2219.4, "standard_charge_percentage": 20.0000, "estimated_amount": 2219, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 198.74, "estimated_amount": 198, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1672.81, "estimated_amount": 1672, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 8322.75, "standard_charge_percentage": 75.0000, "estimated_amount": 8322, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7213.05, "standard_charge_percentage": 65.0000, "estimated_amount": 7213, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2896.32, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2896, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7767.9, "standard_charge_percentage": 70.0000, "estimated_amount": 7767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3772.98, "standard_charge_percentage": 34.0000, "estimated_amount": 3772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3051.68, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3051, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 198.74, "estimated_amount": 198, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3329.1, "standard_charge_percentage": 30.0000, "estimated_amount": 3329, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" }]}]} , { "description": "Exc face-mm b9+marg 3.1-4 cm", "code_information": [ { "code": "11444", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7866, "discounted_cash": 2195,"minimum": 297.38,"maximum": 6528.78,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2674.44, "standard_charge_percentage": 34.0000, "estimated_amount": 2674, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 297.38, "estimated_amount": 297, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1722.65, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1722, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1442, "estimated_amount": 1442, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1722.65, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1722, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6292.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1573.2, "standard_charge_percentage": 20.0000, "estimated_amount": 1573, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5506.2, "standard_charge_percentage": 70.0000, "estimated_amount": 5506, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 297.38, "estimated_amount": 297, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5112.9, "standard_charge_percentage": 65.0000, "estimated_amount": 5112, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1954.03, "estimated_amount": 1954, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6292.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2163.15, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2163, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1722.65, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1722, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5899.5, "standard_charge_percentage": 75.0000, "estimated_amount": 5899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2101.11, "estimated_amount": 2101, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6292.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6292, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6292.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 5584.86, "standard_charge_percentage": 71.0000, "estimated_amount": 5584, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6292.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2053.03, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2053, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2359.8, "standard_charge_percentage": 30.0000, "estimated_amount": 2359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 6528.78, "standard_charge_percentage": 83.0000, "estimated_amount": 6528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1996.05, "estimated_amount": 1996, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" }]}]} , { "description": "Exc skn hdrdnt ax smplntrm", "code_information": [ { "code": "11450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17149, "discounted_cash": 3878,"minimum": 447.37,"maximum": 14233.7,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3755.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3755, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 13719.2, "standard_charge_percentage": 80.0000, "estimated_amount": 13719, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4475.89, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4475, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5759.08, "estimated_amount": 5759, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13719.2, "standard_charge_percentage": 80.0000, "estimated_amount": 13719, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2357.12, "estimated_amount": 2357, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3755.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3755, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 13719.2, "standard_charge_percentage": 80.0000, "estimated_amount": 13719, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3429.8, "standard_charge_percentage": 20.0000, "estimated_amount": 3429, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 447.37, "estimated_amount": 447, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 12175.8, "standard_charge_percentage": 71.0000, "estimated_amount": 12175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5144.7, "standard_charge_percentage": 30.0000, "estimated_amount": 5144, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13719.2, "standard_charge_percentage": 80.0000, "estimated_amount": 13719, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 12004.3, "standard_charge_percentage": 70.0000, "estimated_amount": 12004, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 447.37, "estimated_amount": 447, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3755.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3755, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5882.93, "estimated_amount": 5882, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 12861.8, "standard_charge_percentage": 75.0000, "estimated_amount": 12861, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4715.98, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4715, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 11146.9, "standard_charge_percentage": 65.0000, "estimated_amount": 11146, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5830.66, "standard_charge_percentage": 34.0000, "estimated_amount": 5830, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6192.56, "estimated_amount": 6192, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 14233.7, "standard_charge_percentage": 83.0000, "estimated_amount": 14233, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2357.12, "estimated_amount": 2357, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 13719.2, "standard_charge_percentage": 80.0000, "estimated_amount": 13719, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "11601", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2104.5, "discounted_cash": 953,"minimum": 233.64,"maximum": 2104.5,"payers_information":[{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 233.64, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1262.82, "estimated_amount": 1262, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 578.74, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1174.42, "estimated_amount": 1174, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1188.16, "estimated_amount": 1188, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1199.68, "estimated_amount": 1199, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 1746.73, "standard_charge_percentage": 83.0000, "estimated_amount": 1746, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 673.44, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 673, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1683.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1683.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 2104.5, "estimated_amount": 2104, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1473.15, "standard_charge_percentage": 70.0000, "estimated_amount": 1473, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 460.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1683.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 631.35, "standard_charge_percentage": 30.0000, "estimated_amount": 631, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1683.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 715.53, "standard_charge_percentage": 34.0000, "estimated_amount": 715, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1683.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 420.9, "standard_charge_percentage": 20.0000, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1672.81, "estimated_amount": 1672, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 460.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 233.64, "estimated_amount": 233, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1578.38, "standard_charge_percentage": 75.0000, "estimated_amount": 1578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1367.92, "standard_charge_percentage": 65.0000, "estimated_amount": 1367, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 460.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 549.27, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1494.19, "standard_charge_percentage": 71.0000, "estimated_amount": 1494, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" }]}]} , { "description": "Exc tr-ext mal+marg 2.1-3 cm", "code_information": [ { "code": "11603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2284.65, "discounted_cash": 953,"minimum": 286.78,"maximum": 2284.65,"payers_information":[{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1672.81, "estimated_amount": 1672, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1827.72, "standard_charge_percentage": 80.0000, "estimated_amount": 1827, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1827.72, "standard_charge_percentage": 80.0000, "estimated_amount": 1827, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 286.78, "estimated_amount": 286, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 685.39, "standard_charge_percentage": 30.0000, "estimated_amount": 685, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1996.05, "estimated_amount": 1996, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1485.02, "standard_charge_percentage": 65.0000, "estimated_amount": 1485, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 776.78, "standard_charge_percentage": 34.0000, "estimated_amount": 776, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 731.09, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 731, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1954.03, "estimated_amount": 1954, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 1896.26, "standard_charge_percentage": 83.0000, "estimated_amount": 1896, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1827.72, "standard_charge_percentage": 80.0000, "estimated_amount": 1827, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 596.29, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 596, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 500.34, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 500, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 500.34, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 500, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 456.93, "standard_charge_percentage": 20.0000, "estimated_amount": 456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2101.11, "estimated_amount": 2101, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 286.78, "estimated_amount": 286, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 500.34, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 500, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1713.49, "standard_charge_percentage": 75.0000, "estimated_amount": 1713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1622.1, "standard_charge_percentage": 71.0000, "estimated_amount": 1622, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1827.72, "standard_charge_percentage": 80.0000, "estimated_amount": 1827, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1599.26, "standard_charge_percentage": 70.0000, "estimated_amount": 1599, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 628.28, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 628, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1827.72, "standard_charge_percentage": 80.0000, "estimated_amount": 1827, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1188.16, "estimated_amount": 1188, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 2284.65, "estimated_amount": 2284, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "11604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5283, "discounted_cash": 953,"minimum": 321.59,"maximum": 4550,"payers_information":[{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1672.81, "estimated_amount": 1672, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3433.95, "standard_charge_percentage": 65.0000, "estimated_amount": 3433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2101.11, "estimated_amount": 2101, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1954.03, "estimated_amount": 1954, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1056.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 321.59, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1996.05, "estimated_amount": 1996, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4226.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4226.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4226.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3962.25, "standard_charge_percentage": 75.0000, "estimated_amount": 3962, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3750.93, "standard_charge_percentage": 71.0000, "estimated_amount": 3750, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1452.83, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1796.22, "standard_charge_percentage": 34.0000, "estimated_amount": 1796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1584.9, "standard_charge_percentage": 30.0000, "estimated_amount": 1584, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 4384.89, "standard_charge_percentage": 83.0000, "estimated_amount": 4384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1156.98, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1156, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1156.98, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4226.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4226.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4226, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3698.1, "standard_charge_percentage": 70.0000, "estimated_amount": 3698, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1156.98, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1378.86, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1378, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 321.59, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1188.16, "estimated_amount": 1188, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" }]}]} , { "description": "Exc tr-ext mal+marg >4 cm", "code_information": [ { "code": "11606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3019.38, "discounted_cash": 2195,"minimum": 470.82,"maximum": 3019.38,"payers_information":[{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2415.5, "standard_charge_percentage": 80.0000, "estimated_amount": 2415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3019.38, "estimated_amount": 3019, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 661.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 661, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 470.82, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 2506.09, "standard_charge_percentage": 83.0000, "estimated_amount": 2506, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 3019.38, "estimated_amount": 3019, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1026.59, "standard_charge_percentage": 34.0000, "estimated_amount": 1026, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 830.33, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 830, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3019.38, "estimated_amount": 3019, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 2415.5, "standard_charge_percentage": 80.0000, "estimated_amount": 2415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2113.57, "standard_charge_percentage": 70.0000, "estimated_amount": 2113, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 661.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 661, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2357.12, "estimated_amount": 2357, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 905.81, "standard_charge_percentage": 30.0000, "estimated_amount": 905, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2357.12, "estimated_amount": 2357, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 603.88, "standard_charge_percentage": 20.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1962.6, "standard_charge_percentage": 65.0000, "estimated_amount": 1962, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 788.06, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 788, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2415.5, "standard_charge_percentage": 80.0000, "estimated_amount": 2415, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 2415.5, "standard_charge_percentage": 80.0000, "estimated_amount": 2415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 470.82, "estimated_amount": 470, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 2264.53, "standard_charge_percentage": 75.0000, "estimated_amount": 2264, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 3019.38, "estimated_amount": 3019, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 2415.5, "standard_charge_percentage": 80.0000, "estimated_amount": 2415, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 661.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 661, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2143.76, "standard_charge_percentage": 71.0000, "estimated_amount": 2143, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3019.38, "estimated_amount": 3019, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" }]}]} , { "description": "Exc snhfg mal+mrg 2.1-3", "code_information": [ { "code": "11623", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4368, "discounted_cash": 2195,"minimum": 305.44,"maximum": 4368,"payers_information":[{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3494.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3494, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4368, "estimated_amount": 4368, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4334.56, "estimated_amount": 4334, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3101.28, "standard_charge_percentage": 71.0000, "estimated_amount": 3101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 956.59, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1397.76, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 1397, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1092, "standard_charge_percentage": 25.0000, "estimated_amount": 1092, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4368, "estimated_amount": 4368, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 305.44, "estimated_amount": 305, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3057.6, "standard_charge_percentage": 70.0000, "estimated_amount": 3057, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3625.44, "standard_charge_percentage": 83.0000, "estimated_amount": 3625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2839.2, "standard_charge_percentage": 65.0000, "estimated_amount": 2839, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 873.6, "standard_charge_percentage": 20.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3276, "standard_charge_percentage": 75.0000, "estimated_amount": 3276, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1201.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3494.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3494, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3494.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3494, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4368, "estimated_amount": 4368, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 305.44, "estimated_amount": 305, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1140.05, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1140, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 956.59, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3494.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3494, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1485.12, "standard_charge_percentage": 34.0000, "estimated_amount": 1485, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1310.4, "standard_charge_percentage": 30.0000, "estimated_amount": 1310, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3494.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3494, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 956.59, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 956, "methodology": "percent of total billed charges" }]}]} , { "description": "Exc s/n/h/f/g mal+mrg 3.1-4", "code_information": [ { "code": "11624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9090, "discounted_cash": 2195,"minimum": 349.42,"maximum": 7544.7,"payers_information":[{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 349.42, "estimated_amount": 349, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 349.42, "estimated_amount": 349, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 7272, "standard_charge_percentage": 80.0000, "estimated_amount": 7272, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4334.56, "estimated_amount": 4334, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5908.5, "standard_charge_percentage": 65.0000, "estimated_amount": 5908, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1990.71, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1990, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 7272, "standard_charge_percentage": 80.0000, "estimated_amount": 7272, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1990.71, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1990, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1818, "standard_charge_percentage": 20.0000, "estimated_amount": 1818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6453.9, "standard_charge_percentage": 71.0000, "estimated_amount": 6453, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4427.78, "estimated_amount": 4427, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3090.6, "standard_charge_percentage": 34.0000, "estimated_amount": 3090, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2372.49, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2372, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2499.75, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7272, "standard_charge_percentage": 80.0000, "estimated_amount": 7272, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6817.5, "standard_charge_percentage": 75.0000, "estimated_amount": 6817, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7544.7, "standard_charge_percentage": 83.0000, "estimated_amount": 7544, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7272, "standard_charge_percentage": 80.0000, "estimated_amount": 7272, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 7272, "standard_charge_percentage": 80.0000, "estimated_amount": 7272, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4660.82, "estimated_amount": 4660, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6363, "standard_charge_percentage": 70.0000, "estimated_amount": 6363, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1990.71, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1990, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2727, "standard_charge_percentage": 30.0000, "estimated_amount": 2727, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" }]}]} , { "description": "Exc snhfg mal+mrg >4 cm", "code_information": [ { "code": "11626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8559, "discounted_cash": 3878,"minimum": 426.43,"maximum": 7103.97,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6847.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6847, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7103.97, "standard_charge_percentage": 83.0000, "estimated_amount": 7103, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5991.3, "standard_charge_percentage": 70.0000, "estimated_amount": 5991, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1711.8, "standard_charge_percentage": 20.0000, "estimated_amount": 1711, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1874.42, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6847.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6847, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1874.42, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5563.35, "standard_charge_percentage": 65.0000, "estimated_amount": 5563, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2353.72, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2353, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2357.12, "estimated_amount": 2357, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6847.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6847, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5882.93, "estimated_amount": 5882, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5759.08, "estimated_amount": 5759, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 426.43, "estimated_amount": 426, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 426.43, "estimated_amount": 426, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6192.56, "estimated_amount": 6192, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6076.89, "standard_charge_percentage": 71.0000, "estimated_amount": 6076, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2567.7, "standard_charge_percentage": 30.0000, "estimated_amount": 2567, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6847.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6847, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2233.9, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2233, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2357.12, "estimated_amount": 2357, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6419.25, "standard_charge_percentage": 75.0000, "estimated_amount": 6419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2910.06, "standard_charge_percentage": 34.0000, "estimated_amount": 2910, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1874.42, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6847.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6847, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "11643", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2520, "discounted_cash": 2195,"minimum": 327.71,"maximum": 2520,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2101.11, "estimated_amount": 2101, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1954.03, "estimated_amount": 1954, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 327.71, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2520, "estimated_amount": 2520, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 551.88, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 551, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2520, "estimated_amount": 2520, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 551.88, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 551, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 657.72, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1638, "standard_charge_percentage": 65.0000, "estimated_amount": 1638, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 2016, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 2016, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 2016, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1890, "standard_charge_percentage": 75.0000, "estimated_amount": 1890, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 856.8, "standard_charge_percentage": 34.0000, "estimated_amount": 856, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2520, "estimated_amount": 2520, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 504, "standard_charge_percentage": 20.0000, "estimated_amount": 504, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 693, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 693, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1764, "standard_charge_percentage": 70.0000, "estimated_amount": 1764, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 2520, "estimated_amount": 2520, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1996.05, "estimated_amount": 1996, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 2520, "estimated_amount": 2520, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 806.4, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 806, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 327.71, "estimated_amount": 327, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2016, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 2091.6, "standard_charge_percentage": 83.0000, "estimated_amount": 2091, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2016, "standard_charge_percentage": 80.0000, "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 551.88, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 551, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 756, "standard_charge_percentage": 30.0000, "estimated_amount": 756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2520, "estimated_amount": 2520, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1789.2, "standard_charge_percentage": 71.0000, "estimated_amount": 1789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" }]}]} , { "description": "Exc feenl mal+mrg 3.1-4", "code_information": [ { "code": "11644", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9798.67, "discounted_cash": 2195,"minimum": 404.86,"maximum": 8132.9,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2694.63, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 7838.94, "standard_charge_percentage": 80.0000, "estimated_amount": 7838, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7838.94, "standard_charge_percentage": 80.0000, "estimated_amount": 7838, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 6369.14, "standard_charge_percentage": 65.0000, "estimated_amount": 6369, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2557.45, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2557, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 404.86, "estimated_amount": 404, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6859.07, "standard_charge_percentage": 70.0000, "estimated_amount": 6859, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4427.78, "estimated_amount": 4427, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 7838.94, "standard_charge_percentage": 80.0000, "estimated_amount": 7838, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1959.73, "standard_charge_percentage": 20.0000, "estimated_amount": 1959, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4334.56, "estimated_amount": 4334, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6957.06, "standard_charge_percentage": 71.0000, "estimated_amount": 6957, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2145.91, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2145, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 8132.9, "standard_charge_percentage": 83.0000, "estimated_amount": 8132, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2939.6, "standard_charge_percentage": 30.0000, "estimated_amount": 2939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2145.91, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2145, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2145.91, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2145, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3331.55, "standard_charge_percentage": 34.0000, "estimated_amount": 3331, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 7838.94, "standard_charge_percentage": 80.0000, "estimated_amount": 7838, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7838.94, "standard_charge_percentage": 80.0000, "estimated_amount": 7838, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4660.82, "estimated_amount": 4660, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 404.86, "estimated_amount": 404, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 7349, "standard_charge_percentage": 75.0000, "estimated_amount": 7349, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "11646", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3864, "discounted_cash": 3878,"minimum": 488,"maximum": 3864,"payers_information":[{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3091.2, "standard_charge_percentage": 80.0000, "estimated_amount": 3091, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1313.76, "standard_charge_percentage": 34.0000, "estimated_amount": 1313, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 3864, "estimated_amount": 3864, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 3864, "estimated_amount": 3864, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 3864, "estimated_amount": 3864, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 846.22, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 846, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3864, "estimated_amount": 3864, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 772.8, "standard_charge_percentage": 20.0000, "estimated_amount": 772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3091.2, "standard_charge_percentage": 80.0000, "estimated_amount": 3091, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3091.2, "standard_charge_percentage": 80.0000, "estimated_amount": 3091, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3091.2, "standard_charge_percentage": 80.0000, "estimated_amount": 3091, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2357.12, "estimated_amount": 2357, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 3864, "estimated_amount": 3864, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 530.94, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2511.6, "standard_charge_percentage": 65.0000, "estimated_amount": 2511, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3207.12, "standard_charge_percentage": 83.0000, "estimated_amount": 3207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3091.2, "standard_charge_percentage": 80.0000, "estimated_amount": 3091, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 3864, "estimated_amount": 3864, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 3864, "estimated_amount": 3864, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2357.12, "estimated_amount": 2357, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 3864, "estimated_amount": 3864, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 846.22, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 846, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 2898, "standard_charge_percentage": 75.0000, "estimated_amount": 2898, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2704.8, "standard_charge_percentage": 70.0000, "estimated_amount": 2704, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 846.22, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 846, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2743.44, "standard_charge_percentage": 71.0000, "estimated_amount": 2743, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3864, "estimated_amount": 3864, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1159.2, "standard_charge_percentage": 30.0000, "estimated_amount": 1159, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 530.94, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 3864, "estimated_amount": 3864, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1062.6, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1062, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1008.5, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1008, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3864, "estimated_amount": 3864, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" }]}]} , { "description": "Hc Removal Of Nail Plate", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 459, "discounted_cash": 269,"minimum": 83.41,"maximum": 5229,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 367.2, "standard_charge_percentage": 80.0000, "estimated_amount": 367, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 87.59, "estimated_amount": 87, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 279.61, "estimated_amount": 279, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 115.2, "estimated_amount": 115, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2142, "standard_charge_percentage": 34.0000, "estimated_amount": 2142, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 248.54, "estimated_amount": 248, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 87.59, "estimated_amount": 87, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 367.2, "standard_charge_percentage": 80.0000, "estimated_amount": 367, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1644.3, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1644, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 459, "estimated_amount": 459, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 335.53, "estimated_amount": 335, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 298.35, "standard_charge_percentage": 65.0000, "estimated_amount": 298, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5229, "standard_charge_percentage": 83.0000, "estimated_amount": 5229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 119.8, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 119, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1732.5, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 202.98, "estimated_amount": 202, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1890, "standard_charge_percentage": 30.0000, "estimated_amount": 1890, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5040, "standard_charge_percentage": 80.0000, "estimated_amount": 5040, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 367.2, "standard_charge_percentage": 80.0000, "estimated_amount": 367, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 114.75, "standard_charge_percentage": 25.0000, "estimated_amount": 114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 156.06, "standard_charge_percentage": 34.0000, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 472.4, "estimated_amount": 472, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 289.97, "estimated_amount": 289, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 83.42, "estimated_amount": 83, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1379.7, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1379, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5040, "standard_charge_percentage": 80.0000, "estimated_amount": 5040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 83.42, "estimated_amount": 83, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 83.42, "estimated_amount": 83, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 3351.6, "standard_charge_percentage": 53.2000, "estimated_amount": 3351, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1379.7, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1379, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 248.54, "estimated_amount": 248, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 91.8, "standard_charge_percentage": 20.0000, "estimated_amount": 91, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5040, "standard_charge_percentage": 80.0000, "estimated_amount": 5040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1575, "standard_charge_percentage": 25.0000, "estimated_amount": 1575, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 137.7, "standard_charge_percentage": 30.0000, "estimated_amount": 137, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5040, "standard_charge_percentage": 80.0000, "estimated_amount": 5040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 146.88, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 146, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 279.61, "estimated_amount": 279, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3184.02, "standard_charge_percentage": 53.2000, "estimated_amount": 3184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 3116.99, "standard_charge_percentage": 53.2000, "estimated_amount": 3116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 115.2, "estimated_amount": 115, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 238.19, "estimated_amount": 238, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 202.98, "estimated_amount": 202, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5040, "standard_charge_percentage": 80.0000, "estimated_amount": 5040, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 227.83, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 83.42, "estimated_amount": 83, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 244.19, "standard_charge_percentage": 53.2000, "estimated_amount": 244, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 115.2, "estimated_amount": 115, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 367.2, "standard_charge_percentage": 80.0000, "estimated_amount": 367, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 231.98, "standard_charge_percentage": 53.2000, "estimated_amount": 231, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 321.3, "standard_charge_percentage": 70.0000, "estimated_amount": 321, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4725, "standard_charge_percentage": 75.0000, "estimated_amount": 4725, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 196.76, "estimated_amount": 196, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 258.9, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 115.2, "estimated_amount": 115, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 100.52, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 100, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 289.97, "estimated_amount": 289, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 227.83, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4095, "standard_charge_percentage": 65.0000, "estimated_amount": 4095, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1379.7, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1379, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1260, "standard_charge_percentage": 20.0000, "estimated_amount": 1260, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 310.68, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4473, "standard_charge_percentage": 71.0000, "estimated_amount": 4473, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 227.09, "standard_charge_percentage": 53.2000, "estimated_amount": 227, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2016, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 380.97, "standard_charge_percentage": 83.0000, "estimated_amount": 380, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 258.9, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 367.2, "standard_charge_percentage": 80.0000, "estimated_amount": 367, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 83.42, "estimated_amount": 83, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 310.68, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 325.89, "standard_charge_percentage": 71.0000, "estimated_amount": 325, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 459, "estimated_amount": 459, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 459, "estimated_amount": 459, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 100.52, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 100, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 238.19, "estimated_amount": 238, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 344.25, "standard_charge_percentage": 75.0000, "estimated_amount": 344, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 83.42, "estimated_amount": 83, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 335.53, "estimated_amount": 335, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 196.76, "estimated_amount": 196, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4410, "standard_charge_percentage": 70.0000, "estimated_amount": 4410, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 100.52, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 100, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 126.22, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 126, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "11732", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2157.89,"minimum": 33.2,"maximum": 2157.89,"payers_information":[{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1532.1, "standard_charge_percentage": 71.0000, "estimated_amount": 1532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 690.52, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 690, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1726.31, "standard_charge_percentage": 80.0000, "estimated_amount": 1726, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 472.58, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 472, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1067.64, "standard_charge_percentage": 53.2000, "estimated_amount": 1067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 83.42, "estimated_amount": 83, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 33.2, "estimated_amount": 33, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 647.37, "standard_charge_percentage": 30.0000, "estimated_amount": 647, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 33.2, "estimated_amount": 33, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 83.42, "estimated_amount": 83, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 1791.05, "standard_charge_percentage": 83.0000, "estimated_amount": 1791, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 593.42, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 593, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1726.31, "standard_charge_percentage": 80.0000, "estimated_amount": 1726, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 83.42, "estimated_amount": 83, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 83.42, "estimated_amount": 83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 733.68, "standard_charge_percentage": 34.0000, "estimated_amount": 733, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 539.47, "standard_charge_percentage": 25.0000, "estimated_amount": 539, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1618.42, "standard_charge_percentage": 75.0000, "estimated_amount": 1618, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1402.63, "standard_charge_percentage": 65.0000, "estimated_amount": 1402, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1726.31, "standard_charge_percentage": 80.0000, "estimated_amount": 1726, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 2157.89, "estimated_amount": 2157, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 87.59, "estimated_amount": 87, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 87.59, "estimated_amount": 87, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 472.58, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 472, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1726.31, "standard_charge_percentage": 80.0000, "estimated_amount": 1726, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 83.42, "estimated_amount": 83, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1726.31, "standard_charge_percentage": 80.0000, "estimated_amount": 1726, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 563.21, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 563, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 83.42, "estimated_amount": 83, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1510.52, "standard_charge_percentage": 70.0000, "estimated_amount": 1510, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1090.6, "standard_charge_percentage": 53.2000, "estimated_amount": 1090, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 472.58, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 472, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 431.58, "standard_charge_percentage": 20.0000, "estimated_amount": 431, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1148, "standard_charge_percentage": 53.2000, "estimated_amount": 1148, "methodology": "percent of total billed charges" }]}]} , { "description": "Drain blood from under nail", "code_information": [ { "code": "11740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 259, "discounted_cash": 174,"minimum": 51.8,"maximum": 259,"payers_information":[{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 83.42, "estimated_amount": 83, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 56.72, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 56, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 134.36, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 181.39, "estimated_amount": 181, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 83.42, "estimated_amount": 83, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 134.36, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 77.7, "standard_charge_percentage": 30.0000, "estimated_amount": 77, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 181.3, "standard_charge_percentage": 70.0000, "estimated_amount": 181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 161.23, "estimated_amount": 161, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 207.2, "standard_charge_percentage": 80.0000, "estimated_amount": 207, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 167.95, "estimated_amount": 167, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 58.02, "estimated_amount": 58, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 208.26, "estimated_amount": 208, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 141.08, "estimated_amount": 141, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 134.36, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 259, "estimated_amount": 259, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 88.06, "standard_charge_percentage": 34.0000, "estimated_amount": 88, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 83.42, "estimated_amount": 83, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 87.59, "estimated_amount": 87, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 183.89, "standard_charge_percentage": 71.0000, "estimated_amount": 183, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 188.1, "estimated_amount": 188, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 58.02, "estimated_amount": 58, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 134.36, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 128.14, "standard_charge_percentage": 53.2000, "estimated_amount": 128, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 201.54, "estimated_amount": 201, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 207.2, "standard_charge_percentage": 80.0000, "estimated_amount": 207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 208.26, "estimated_amount": 208, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 138.39, "estimated_amount": 138, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 207.2, "standard_charge_percentage": 80.0000, "estimated_amount": 207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 134.36, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 138.39, "estimated_amount": 138, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 83.42, "estimated_amount": 83, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 127.64, "estimated_amount": 127, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 134.36, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 134.36, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 138.39, "estimated_amount": 138, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 259, "estimated_amount": 259, "methodology": "case rate" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 82.88, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 82, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 134.36, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 207.2, "standard_charge_percentage": 80.0000, "estimated_amount": 207, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 194.25, "standard_charge_percentage": 75.0000, "estimated_amount": 194, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 134.36, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 83.42, "estimated_amount": 83, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 51.8, "standard_charge_percentage": 20.0000, "estimated_amount": 51, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 56.72, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 56, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 71.22, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 71, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 217.66, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 141.08, "estimated_amount": 141, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 131.67, "estimated_amount": 131, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 134.36, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 207.2, "standard_charge_percentage": 80.0000, "estimated_amount": 207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 130.9, "standard_charge_percentage": 53.2000, "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 134.36, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 134.36, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 87.59, "estimated_amount": 87, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 141.08, "estimated_amount": 141, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 134.36, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 259, "estimated_amount": 259, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 134.36, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 147.8, "estimated_amount": 147, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 83.42, "estimated_amount": 83, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 154.51, "estimated_amount": 154, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 137.79, "standard_charge_percentage": 53.2000, "estimated_amount": 137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 64.75, "standard_charge_percentage": 25.0000, "estimated_amount": 64, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 67.6, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 67, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 141.08, "estimated_amount": 141, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 214.97, "standard_charge_percentage": 83.0000, "estimated_amount": 214, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 56.72, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 56, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 134.36, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 168.35, "standard_charge_percentage": 65.0000, "estimated_amount": 168, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 134.36, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 134.36, "estimated_amount": 134, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 134.36, "estimated_amount": 134, "methodology": "fee schedule" }]}]} , { "description": "Hc Removal Of Nail Bed", "code_information": [ { "code": "11750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 554, "discounted_cash": 541,"minimum": 110.8,"maximum": 7859.27,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 166.2, "standard_charge_percentage": 30.0000, "estimated_amount": 166, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 443.2, "standard_charge_percentage": 80.0000, "estimated_amount": 443, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 6154.85, "standard_charge_percentage": 65.0000, "estimated_amount": 6154, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 554, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 387.8, "standard_charge_percentage": 70.0000, "estimated_amount": 387, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 554, "estimated_amount": 554, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 554, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 554, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 949.88, "estimated_amount": 949, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 188.36, "standard_charge_percentage": 34.0000, "estimated_amount": 188, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 443.2, "standard_charge_percentage": 80.0000, "estimated_amount": 443, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1893.8, "standard_charge_percentage": 20.0000, "estimated_amount": 1893, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 443.2, "standard_charge_percentage": 80.0000, "estimated_amount": 443, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7575.2, "standard_charge_percentage": 80.0000, "estimated_amount": 7575, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 7575.2, "standard_charge_percentage": 80.0000, "estimated_amount": 7575, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 459.82, "standard_charge_percentage": 83.0000, "estimated_amount": 459, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 443.2, "standard_charge_percentage": 80.0000, "estimated_amount": 443, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 110.8, "standard_charge_percentage": 20.0000, "estimated_amount": 110, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 554, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 554, "estimated_amount": 554, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2603.97, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6722.99, "standard_charge_percentage": 71.0000, "estimated_amount": 6722, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2471.41, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2840.7, "standard_charge_percentage": 30.0000, "estimated_amount": 2840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 162.2, "estimated_amount": 162, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3030.08, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 3030, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 554, "estimated_amount": 554, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 162.2, "estimated_amount": 162, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2073.71, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2073, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 121.33, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7575.2, "standard_charge_percentage": 80.0000, "estimated_amount": 7575, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3219.46, "standard_charge_percentage": 34.0000, "estimated_amount": 3219, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 7575.2, "standard_charge_percentage": 80.0000, "estimated_amount": 7575, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1262.82, "estimated_amount": 1262, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 415.5, "standard_charge_percentage": 75.0000, "estimated_amount": 415, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1174.42, "estimated_amount": 1174, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 152.35, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 554, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 7575.2, "standard_charge_percentage": 80.0000, "estimated_amount": 7575, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 177.28, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 177, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 674.68, "estimated_amount": 674, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6628.3, "standard_charge_percentage": 70.0000, "estimated_amount": 6628, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 443.2, "standard_charge_percentage": 80.0000, "estimated_amount": 443, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 554, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 162.2, "estimated_amount": 162, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 144.59, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 144, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1199.68, "estimated_amount": 1199, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 360.1, "standard_charge_percentage": 65.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7859.27, "standard_charge_percentage": 83.0000, "estimated_amount": 7859, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 554, "estimated_amount": 554, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 162.2, "estimated_amount": 162, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 393.34, "standard_charge_percentage": 71.0000, "estimated_amount": 393, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2073.71, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2073, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 121.33, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 554, "estimated_amount": 554, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 121.33, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2073.71, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2073, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 7101.75, "standard_charge_percentage": 75.0000, "estimated_amount": 7101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 554, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" }]}]} , { "description": "Biopsy nail unit", "code_information": [ { "code": "11755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3795, "discounted_cash": 953,"minimum": 123.02,"maximum": 3795,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3036, "standard_charge_percentage": 80.0000, "estimated_amount": 3036, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 831.11, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3036, "standard_charge_percentage": 80.0000, "estimated_amount": 3036, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 831.11, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1043.63, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1043, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3795, "estimated_amount": 3795, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 123.02, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1199.68, "estimated_amount": 1199, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 990.5, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 990, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1188.16, "estimated_amount": 1188, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2656.5, "standard_charge_percentage": 70.0000, "estimated_amount": 2656, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3149.85, "standard_charge_percentage": 83.0000, "estimated_amount": 3149, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1174.42, "estimated_amount": 1174, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2694.45, "standard_charge_percentage": 71.0000, "estimated_amount": 2694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3036, "standard_charge_percentage": 80.0000, "estimated_amount": 3036, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 759, "standard_charge_percentage": 20.0000, "estimated_amount": 759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1262.82, "estimated_amount": 1262, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 123.02, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1214.4, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 1214, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3036, "standard_charge_percentage": 80.0000, "estimated_amount": 3036, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 831.11, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1290.3, "standard_charge_percentage": 34.0000, "estimated_amount": 1290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 2846.25, "standard_charge_percentage": 75.0000, "estimated_amount": 2846, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3036, "standard_charge_percentage": 80.0000, "estimated_amount": 3036, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2466.75, "standard_charge_percentage": 65.0000, "estimated_amount": 2466, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1138.5, "standard_charge_percentage": 30.0000, "estimated_amount": 1138, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1672.81, "estimated_amount": 1672, "methodology": "fee schedule" }]}]} , { "description": "Remove pilonidal cyst simple", "code_information": [ { "code": "11770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8528, "discounted_cash": 3878,"minimum": 363.07,"maximum": 7078.24,"payers_information":[{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5759.08, "estimated_amount": 5759, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5543.2, "standard_charge_percentage": 65.0000, "estimated_amount": 5543, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5969.6, "standard_charge_percentage": 70.0000, "estimated_amount": 5969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 363.07, "estimated_amount": 363, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 363.07, "estimated_amount": 363, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6192.56, "estimated_amount": 6192, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2558.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2558, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2899.52, "standard_charge_percentage": 34.0000, "estimated_amount": 2899, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2345.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2345, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7078.24, "standard_charge_percentage": 83.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6054.88, "standard_charge_percentage": 71.0000, "estimated_amount": 6054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2225.81, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2225, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5882.93, "estimated_amount": 5882, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1594.68, "estimated_amount": 1594, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1518.74, "estimated_amount": 1518, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6396, "standard_charge_percentage": 75.0000, "estimated_amount": 6396, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1705.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1705, "methodology": "percent of total billed charges" }]}]} , { "description": "Remove pilonidal cyst exten", "code_information": [ { "code": "11771", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10838, "discounted_cash": 3878,"minimum": 558,"maximum": 8995.54,"payers_information":[{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3684.92, "standard_charge_percentage": 34.0000, "estimated_amount": 3684, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3251.4, "standard_charge_percentage": 30.0000, "estimated_amount": 3251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8670.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8670, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 666.98, "estimated_amount": 666, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2357.12, "estimated_amount": 2357, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7044.7, "standard_charge_percentage": 65.0000, "estimated_amount": 7044, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5882.93, "estimated_amount": 5882, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2373.52, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2373, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2373.52, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2373, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 8995.54, "standard_charge_percentage": 83.0000, "estimated_amount": 8995, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2373.52, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2373, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7586.6, "standard_charge_percentage": 70.0000, "estimated_amount": 7586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6192.56, "estimated_amount": 6192, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8670.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8670, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2357.12, "estimated_amount": 2357, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8670.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8670, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8670.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8670, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2980.45, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2980, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2828.72, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2828, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8670.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8670, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5759.08, "estimated_amount": 5759, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 666.98, "estimated_amount": 666, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7694.98, "standard_charge_percentage": 71.0000, "estimated_amount": 7694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2167.6, "standard_charge_percentage": 20.0000, "estimated_amount": 2167, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 8128.5, "standard_charge_percentage": 75.0000, "estimated_amount": 8128, "methodology": "percent of total billed charges" }]}]} , { "description": "Remove pilonidal cyst compl", "code_information": [ { "code": "11772", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13148, "discounted_cash": 3878,"minimum": 558,"maximum": 10912.8,"payers_information":[{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 817.62, "estimated_amount": 817, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9861, "standard_charge_percentage": 75.0000, "estimated_amount": 9861, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5759.08, "estimated_amount": 5759, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10518, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2879.41, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5882.93, "estimated_amount": 5882, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 817.62, "estimated_amount": 817, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3944.4, "standard_charge_percentage": 30.0000, "estimated_amount": 3944, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2879.41, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3431.63, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3431, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3615.7, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3615, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2879.41, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8546.2, "standard_charge_percentage": 65.0000, "estimated_amount": 8546, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2357.12, "estimated_amount": 2357, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9203.6, "standard_charge_percentage": 70.0000, "estimated_amount": 9203, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4470.32, "standard_charge_percentage": 34.0000, "estimated_amount": 4470, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2357.12, "estimated_amount": 2357, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2629.6, "standard_charge_percentage": 20.0000, "estimated_amount": 2629, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6192.56, "estimated_amount": 6192, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2244.88, "estimated_amount": 2244, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9335.08, "standard_charge_percentage": 71.0000, "estimated_amount": 9335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10912.8, "standard_charge_percentage": 83.0000, "estimated_amount": 10912, "methodology": "percent of total billed charges" }]}]} , { "description": "Rplcmt tiss xpndr perm implt", "code_information": [ { "code": "11970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8301, "discounted_cash": 9680,"minimum": 558,"maximum": 8301,"payers_information":[{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8301, "estimated_amount": 8301, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1660.2, "standard_charge_percentage": 20.0000, "estimated_amount": 1660, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 5893.71, "standard_charge_percentage": 71.0000, "estimated_amount": 5893, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8301, "estimated_amount": 8301, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2822.34, "standard_charge_percentage": 34.0000, "estimated_amount": 2822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6225.75, "standard_charge_percentage": 75.0000, "estimated_amount": 6225, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 607.05, "estimated_amount": 607, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6640.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6640, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1817.92, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1817, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 8301, "estimated_amount": 8301, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 8301, "estimated_amount": 8301, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 8301, "estimated_amount": 8301, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 6889.83, "standard_charge_percentage": 83.0000, "estimated_amount": 6889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1817.92, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1817, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6640.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6640, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4289.37, "estimated_amount": 4289, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 8301, "estimated_amount": 8301, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 607.05, "estimated_amount": 607, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 8301, "estimated_amount": 8301, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5810.7, "standard_charge_percentage": 70.0000, "estimated_amount": 5810, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4289.37, "estimated_amount": 4289, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5395.65, "standard_charge_percentage": 65.0000, "estimated_amount": 5395, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 8301, "estimated_amount": 8301, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1817.92, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1817, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8301, "estimated_amount": 8301, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 8301, "estimated_amount": 8301, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2166.56, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2166, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 8301, "estimated_amount": 8301, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 8301, "estimated_amount": 8301, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 8301, "estimated_amount": 8301, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6640.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6640, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6640.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6640, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2490.3, "standard_charge_percentage": 30.0000, "estimated_amount": 2490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6640.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6640, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2282.78, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2282, "methodology": "percent of total billed charges" }]}]} , { "description": "Remove drug implant device", "code_information": [ { "code": "11982", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8528, "discounted_cash": 540,"minimum": 116.24,"maximum": 7078.24,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 436.76, "estimated_amount": 436, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 561.55, "estimated_amount": 561, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.35, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2728.96, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1705.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 623.94, "estimated_amount": 623, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2558.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2558, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2345.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2345, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 673.86, "estimated_amount": 673, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 436.76, "estimated_amount": 436, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5543.2, "standard_charge_percentage": 65.0000, "estimated_amount": 5543, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 644.74, "estimated_amount": 644, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.44, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4219.31, "standard_charge_percentage": 53.2000, "estimated_amount": 4219, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2899.52, "standard_charge_percentage": 34.0000, "estimated_amount": 2899, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 457.56, "estimated_amount": 457, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 644.74, "estimated_amount": 644, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6396, "standard_charge_percentage": 75.0000, "estimated_amount": 6396, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 116.24, "estimated_amount": 116, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 948.72, "estimated_amount": 948, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 519.95, "estimated_amount": 519, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 582.34, "estimated_amount": 582, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2225.81, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2225, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.44, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7078.24, "standard_charge_percentage": 83.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4310.05, "standard_charge_percentage": 53.2000, "estimated_amount": 4310, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6054.88, "standard_charge_percentage": 71.0000, "estimated_amount": 6054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4536.9, "standard_charge_percentage": 53.2000, "estimated_amount": 4536, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5969.6, "standard_charge_percentage": 70.0000, "estimated_amount": 5969, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.16, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 415.96, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 2132, "standard_charge_percentage": 25.0000, "estimated_amount": 2132, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.44, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 436.76, "estimated_amount": 436, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 116.24, "estimated_amount": 116, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.15, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 436.76, "estimated_amount": 436, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 407.64, "estimated_amount": 407, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Smp Body/Scalp/Extr <2.5 Cm", "code_information": [ { "code": "12001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 354, "discounted_cash": 269,"minimum": 70.8,"maximum": 354,"payers_information":[{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 113.28, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 113, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 279.61, "estimated_amount": 279, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 247.8, "standard_charge_percentage": 70.0000, "estimated_amount": 247, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 196.76, "estimated_amount": 196, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 77.53, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 77, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 283.2, "standard_charge_percentage": 80.0000, "estimated_amount": 283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 92.39, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 92, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 230.1, "standard_charge_percentage": 65.0000, "estimated_amount": 230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 188.33, "standard_charge_percentage": 53.2000, "estimated_amount": 188, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 88.5, "standard_charge_percentage": 25.0000, "estimated_amount": 88, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 289.97, "estimated_amount": 289, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 98.03, "estimated_amount": 98, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 248.54, "estimated_amount": 248, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 310.68, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 97.35, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 97, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 175.15, "standard_charge_percentage": 53.2000, "estimated_amount": 175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 77.53, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 77, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 227.83, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 283.2, "standard_charge_percentage": 80.0000, "estimated_amount": 283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 98.03, "estimated_amount": 98, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 354, "estimated_amount": 354, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 283.2, "standard_charge_percentage": 80.0000, "estimated_amount": 283, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 354, "estimated_amount": 354, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 335.53, "estimated_amount": 335, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 258.9, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 106.2, "standard_charge_percentage": 30.0000, "estimated_amount": 106, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 70.8, "standard_charge_percentage": 20.0000, "estimated_amount": 70, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 283.2, "standard_charge_percentage": 80.0000, "estimated_amount": 283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 202.98, "estimated_amount": 202, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 238.19, "estimated_amount": 238, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 293.82, "standard_charge_percentage": 83.0000, "estimated_amount": 293, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 251.34, "standard_charge_percentage": 71.0000, "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 354, "estimated_amount": 354, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 178.91, "standard_charge_percentage": 53.2000, "estimated_amount": 178, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 120.36, "standard_charge_percentage": 34.0000, "estimated_amount": 120, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 265.5, "standard_charge_percentage": 75.0000, "estimated_amount": 265, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 77.53, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 77, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 283.2, "standard_charge_percentage": 80.0000, "estimated_amount": 283, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Smp Body/Scalp/Extr 2.6-7.5 Cm", "code_information": [ { "code": "12002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 704, "discounted_cash": 269,"minimum": 119.99,"maximum": 704,"payers_information":[{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 374.53, "standard_charge_percentage": 53.2000, "estimated_amount": 374, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 154.18, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 154, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 225.28, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 225, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 196.76, "estimated_amount": 196, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 563.2, "standard_charge_percentage": 80.0000, "estimated_amount": 563, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 176, "standard_charge_percentage": 25.0000, "estimated_amount": 176, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 154.18, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 154, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 227.83, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 258.9, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 248.54, "estimated_amount": 248, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 528, "standard_charge_percentage": 75.0000, "estimated_amount": 528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 289.97, "estimated_amount": 289, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 140.8, "standard_charge_percentage": 20.0000, "estimated_amount": 140, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 563.2, "standard_charge_percentage": 80.0000, "estimated_amount": 563, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 183.74, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 183, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 472.4, "estimated_amount": 472, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 119.99, "estimated_amount": 119, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 279.61, "estimated_amount": 279, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 119.99, "estimated_amount": 119, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 563.2, "standard_charge_percentage": 80.0000, "estimated_amount": 563, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 584.32, "standard_charge_percentage": 83.0000, "estimated_amount": 584, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 563.2, "standard_charge_percentage": 80.0000, "estimated_amount": 563, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 211.2, "standard_charge_percentage": 30.0000, "estimated_amount": 211, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 202.98, "estimated_amount": 202, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 499.84, "standard_charge_percentage": 71.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 335.53, "estimated_amount": 335, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 238.19, "estimated_amount": 238, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 704, "estimated_amount": 704, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 239.36, "standard_charge_percentage": 34.0000, "estimated_amount": 239, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 492.8, "standard_charge_percentage": 70.0000, "estimated_amount": 492, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 348.31, "standard_charge_percentage": 53.2000, "estimated_amount": 348, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 154.18, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 154, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 310.68, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 457.6, "standard_charge_percentage": 65.0000, "estimated_amount": 457, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 340.03, "standard_charge_percentage": 48.3000, "estimated_amount": 340, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 355.8, "standard_charge_percentage": 53.2000, "estimated_amount": 355, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 193.6, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 563.2, "standard_charge_percentage": 80.0000, "estimated_amount": 563, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" }]}]} , { "description": "Rpr snaxgentrk7.6-12.5cm", "code_information": [ { "code": "12004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 847, "discounted_cash": 269,"minimum": 140.3,"maximum": 847,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 677.6, "standard_charge_percentage": 80.0000, "estimated_amount": 677, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 847, "estimated_amount": 847, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 635.25, "standard_charge_percentage": 75.0000, "estimated_amount": 635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 592.9, "standard_charge_percentage": 70.0000, "estimated_amount": 592, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 428.07, "standard_charge_percentage": 53.2000, "estimated_amount": 428, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 140.3, "estimated_amount": 140, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 450.6, "standard_charge_percentage": 53.2000, "estimated_amount": 450, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 310.68, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 847, "estimated_amount": 847, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 335.53, "estimated_amount": 335, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 202.98, "estimated_amount": 202, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 419.06, "standard_charge_percentage": 53.2000, "estimated_amount": 419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 211.75, "standard_charge_percentage": 25.0000, "estimated_amount": 211, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 140.3, "estimated_amount": 140, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 232.93, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 232, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 677.6, "standard_charge_percentage": 80.0000, "estimated_amount": 677, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 227.83, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 185.49, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 185, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 601.37, "standard_charge_percentage": 71.0000, "estimated_amount": 601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 703.01, "standard_charge_percentage": 83.0000, "estimated_amount": 703, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 279.61, "estimated_amount": 279, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 677.6, "standard_charge_percentage": 80.0000, "estimated_amount": 677, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 238.19, "estimated_amount": 238, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 271.04, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 271, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 287.98, "standard_charge_percentage": 34.0000, "estimated_amount": 287, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 472.4, "estimated_amount": 472, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 550.55, "standard_charge_percentage": 65.0000, "estimated_amount": 550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 185.49, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 185, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 289.97, "estimated_amount": 289, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 185.49, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 185, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 254.1, "standard_charge_percentage": 30.0000, "estimated_amount": 254, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 677.6, "standard_charge_percentage": 80.0000, "estimated_amount": 677, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 221.07, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 221, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 169.4, "standard_charge_percentage": 20.0000, "estimated_amount": 169, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 677.6, "standard_charge_percentage": 80.0000, "estimated_amount": 677, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 258.9, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 248.54, "estimated_amount": 248, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 196.76, "estimated_amount": 196, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Smp Body/Scalp/Extr 12.6-20 Cm", "code_information": [ { "code": "12005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 931, "discounted_cash": 541,"minimum": 186.2,"maximum": 931,"payers_information":[{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 931, "estimated_amount": 931, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 187.24, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 256.02, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 256, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 744.8, "standard_charge_percentage": 80.0000, "estimated_amount": 744, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 203.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 605.15, "standard_charge_percentage": 65.0000, "estimated_amount": 605, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 460.62, "standard_charge_percentage": 53.2000, "estimated_amount": 460, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 744.8, "standard_charge_percentage": 80.0000, "estimated_amount": 744, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 931, "estimated_amount": 931, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 279.3, "standard_charge_percentage": 30.0000, "estimated_amount": 279, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 203.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 744.8, "standard_charge_percentage": 80.0000, "estimated_amount": 744, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 186.2, "standard_charge_percentage": 20.0000, "estimated_amount": 186, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 674.68, "estimated_amount": 674, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 203.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 203, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 744.8, "standard_charge_percentage": 80.0000, "estimated_amount": 744, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 187.24, "estimated_amount": 187, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 651.7, "standard_charge_percentage": 70.0000, "estimated_amount": 651, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 495.29, "standard_charge_percentage": 53.2000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 744.8, "standard_charge_percentage": 80.0000, "estimated_amount": 744, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 931, "estimated_amount": 931, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 470.53, "standard_charge_percentage": 53.2000, "estimated_amount": 470, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 772.73, "standard_charge_percentage": 83.0000, "estimated_amount": 772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 931, "estimated_amount": 931, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 661.01, "standard_charge_percentage": 71.0000, "estimated_amount": 661, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 698.25, "standard_charge_percentage": 75.0000, "estimated_amount": 698, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 316.54, "standard_charge_percentage": 34.0000, "estimated_amount": 316, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 242.99, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 242, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" }]}]} , { "description": "Rpr feenlm 2.5 cm<", "code_information": [ { "code": "12011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 760, "discounted_cash": 269,"minimum": 117.72,"maximum": 760,"payers_information":[{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 376.02, "standard_charge_percentage": 53.2000, "estimated_amount": 376, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 367.08, "standard_charge_percentage": 48.3000, "estimated_amount": 367, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 248.54, "estimated_amount": 248, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 152, "standard_charge_percentage": 20.0000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 166.44, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 166, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 310.68, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 335.53, "estimated_amount": 335, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 289.97, "estimated_amount": 289, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 472.4, "estimated_amount": 472, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 166.44, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 166, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 279.61, "estimated_amount": 279, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 209, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 209, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 190, "standard_charge_percentage": 25.0000, "estimated_amount": 190, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 198.36, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 198, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 608, "standard_charge_percentage": 80.0000, "estimated_amount": 608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 608, "standard_charge_percentage": 80.0000, "estimated_amount": 608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 117.72, "estimated_amount": 117, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 608, "standard_charge_percentage": 80.0000, "estimated_amount": 608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 202.98, "estimated_amount": 202, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 227.83, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 258.4, "standard_charge_percentage": 34.0000, "estimated_amount": 258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 539.6, "standard_charge_percentage": 71.0000, "estimated_amount": 539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 228, "standard_charge_percentage": 30.0000, "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 384.1, "standard_charge_percentage": 53.2000, "estimated_amount": 384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 243.2, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 243, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 238.19, "estimated_amount": 238, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 166.44, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 166, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 608, "standard_charge_percentage": 80.0000, "estimated_amount": 608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 532, "standard_charge_percentage": 70.0000, "estimated_amount": 532, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 760, "estimated_amount": 760, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 494, "standard_charge_percentage": 65.0000, "estimated_amount": 494, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 404.32, "standard_charge_percentage": 53.2000, "estimated_amount": 404, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 608, "standard_charge_percentage": 80.0000, "estimated_amount": 608, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 630.8, "standard_charge_percentage": 83.0000, "estimated_amount": 630, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 258.9, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 570, "standard_charge_percentage": 75.0000, "estimated_amount": 570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 196.76, "estimated_amount": 196, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 117.72, "estimated_amount": 117, "methodology": "fee schedule" }]}]} , { "description": "Rpr feenlm 2.6-5.0 cm", "code_information": [ { "code": "12013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 811, "discounted_cash": 269,"minimum": 123.24,"maximum": 811,"payers_information":[{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 123.24, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 196.76, "estimated_amount": 196, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 123.24, "estimated_amount": 123, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 227.83, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 258.9, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 811, "estimated_amount": 811, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 575.81, "standard_charge_percentage": 71.0000, "estimated_amount": 575, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 401.25, "standard_charge_percentage": 53.2000, "estimated_amount": 401, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 409.88, "standard_charge_percentage": 53.2000, "estimated_amount": 409, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 259.52, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 259, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 648.8, "standard_charge_percentage": 80.0000, "estimated_amount": 648, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 673.13, "standard_charge_percentage": 83.0000, "estimated_amount": 673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 567.7, "standard_charge_percentage": 70.0000, "estimated_amount": 567, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 211.67, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 211, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 527.15, "standard_charge_percentage": 65.0000, "estimated_amount": 527, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 177.61, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 177, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 648.8, "standard_charge_percentage": 80.0000, "estimated_amount": 648, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 648.8, "standard_charge_percentage": 80.0000, "estimated_amount": 648, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 279.61, "estimated_amount": 279, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 335.53, "estimated_amount": 335, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 177.61, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 177, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 289.97, "estimated_amount": 289, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 238.19, "estimated_amount": 238, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 648.8, "standard_charge_percentage": 80.0000, "estimated_amount": 648, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 177.61, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 177, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 223.03, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 223, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 248.54, "estimated_amount": 248, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 275.74, "standard_charge_percentage": 34.0000, "estimated_amount": 275, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 431.45, "standard_charge_percentage": 53.2000, "estimated_amount": 431, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 648.8, "standard_charge_percentage": 80.0000, "estimated_amount": 648, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 391.71, "standard_charge_percentage": 48.3000, "estimated_amount": 391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 472.4, "estimated_amount": 472, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 202.98, "estimated_amount": 202, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 202.75, "standard_charge_percentage": 25.0000, "estimated_amount": 202, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 243.3, "standard_charge_percentage": 30.0000, "estimated_amount": 243, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 310.68, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 608.25, "standard_charge_percentage": 75.0000, "estimated_amount": 608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 162.2, "standard_charge_percentage": 20.0000, "estimated_amount": 162, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Smp Face 5.1-7.5 Cm", "code_information": [ { "code": "12014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1038, "discounted_cash": 269,"minimum": 149.81,"maximum": 1038,"payers_information":[{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1038, "estimated_amount": 1038, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 830.4, "standard_charge_percentage": 80.0000, "estimated_amount": 830, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 196.76, "estimated_amount": 196, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 279.61, "estimated_amount": 279, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 289.97, "estimated_amount": 289, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 736.98, "standard_charge_percentage": 71.0000, "estimated_amount": 736, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 830.4, "standard_charge_percentage": 80.0000, "estimated_amount": 830, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 335.53, "estimated_amount": 335, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 238.19, "estimated_amount": 238, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 332.16, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 332, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 227.32, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 227, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 202.98, "estimated_amount": 202, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 149.81, "estimated_amount": 149, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 259.5, "standard_charge_percentage": 25.0000, "estimated_amount": 259, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 726.6, "standard_charge_percentage": 70.0000, "estimated_amount": 726, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 258.9, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 861.54, "standard_charge_percentage": 83.0000, "estimated_amount": 861, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 227.32, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 227, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 674.7, "standard_charge_percentage": 65.0000, "estimated_amount": 674, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 310.68, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 248.54, "estimated_amount": 248, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 524.61, "standard_charge_percentage": 53.2000, "estimated_amount": 524, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 311.4, "standard_charge_percentage": 30.0000, "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 472.4, "estimated_amount": 472, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 830.4, "standard_charge_percentage": 80.0000, "estimated_amount": 830, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 285.45, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 285, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1038, "estimated_amount": 1038, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 830.4, "standard_charge_percentage": 80.0000, "estimated_amount": 830, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 830.4, "standard_charge_percentage": 80.0000, "estimated_amount": 830, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 207.6, "standard_charge_percentage": 20.0000, "estimated_amount": 207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 778.5, "standard_charge_percentage": 75.0000, "estimated_amount": 778, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 352.92, "standard_charge_percentage": 34.0000, "estimated_amount": 352, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 149.81, "estimated_amount": 149, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 513.56, "standard_charge_percentage": 53.2000, "estimated_amount": 513, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 227.32, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 227, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 227.83, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 552.22, "standard_charge_percentage": 53.2000, "estimated_amount": 552, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 270.92, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 270, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Smp Face 7.6-12.5 Cm", "code_information": [ { "code": "12015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1323, "discounted_cash": 269,"minimum": 183.59,"maximum": 1323,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 363.82, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 363, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 859.95, "standard_charge_percentage": 65.0000, "estimated_amount": 859, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 238.19, "estimated_amount": 238, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 335.53, "estimated_amount": 335, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1058.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1058, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 1098.09, "standard_charge_percentage": 83.0000, "estimated_amount": 1098, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 992.25, "standard_charge_percentage": 75.0000, "estimated_amount": 992, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 183.59, "estimated_amount": 183, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 703.84, "standard_charge_percentage": 53.2000, "estimated_amount": 703, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 939.33, "standard_charge_percentage": 71.0000, "estimated_amount": 939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 227.83, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1323, "estimated_amount": 1323, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1058.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 396.9, "standard_charge_percentage": 30.0000, "estimated_amount": 396, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 289.74, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 449.82, "standard_charge_percentage": 34.0000, "estimated_amount": 449, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 289.74, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 289, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1058.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 248.54, "estimated_amount": 248, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 289.74, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 310.68, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 926.1, "standard_charge_percentage": 70.0000, "estimated_amount": 926, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 472.4, "estimated_amount": 472, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 423.36, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 264.6, "standard_charge_percentage": 20.0000, "estimated_amount": 264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 196.76, "estimated_amount": 196, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1058.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1058, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 279.61, "estimated_amount": 279, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 345.3, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 345, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1058.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 258.9, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 289.97, "estimated_amount": 289, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 668.64, "standard_charge_percentage": 53.2000, "estimated_amount": 668, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 183.59, "estimated_amount": 183, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 654.57, "standard_charge_percentage": 53.2000, "estimated_amount": 654, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 330.75, "standard_charge_percentage": 25.0000, "estimated_amount": 330, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 202.98, "estimated_amount": 202, "methodology": "fee schedule" }]}]} , { "description": "Rpr feeenlm 12.6-20.0 cm", "code_information": [ { "code": "12016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1802, "discounted_cash": 541,"minimum": 228.87,"maximum": 1802,"payers_information":[{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 235.7, "estimated_amount": 235, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1441.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 674.68, "estimated_amount": 674, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1441.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 235.7, "estimated_amount": 235, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 612.68, "standard_charge_percentage": 34.0000, "estimated_amount": 612, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 360.4, "standard_charge_percentage": 20.0000, "estimated_amount": 360, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 910.73, "standard_charge_percentage": 53.2000, "estimated_amount": 910, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 949.88, "estimated_amount": 949, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 495.55, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 891.56, "standard_charge_percentage": 53.2000, "estimated_amount": 891, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 470.32, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 470, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1441.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1441, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1441.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1441, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 394.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 394, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 540.6, "standard_charge_percentage": 30.0000, "estimated_amount": 540, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1261.4, "standard_charge_percentage": 70.0000, "estimated_amount": 1261, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 1495.66, "standard_charge_percentage": 83.0000, "estimated_amount": 1495, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1171.3, "standard_charge_percentage": 65.0000, "estimated_amount": 1171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1279.42, "standard_charge_percentage": 71.0000, "estimated_amount": 1279, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 394.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 394, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1351.5, "standard_charge_percentage": 75.0000, "estimated_amount": 1351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1802, "estimated_amount": 1802, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 958.66, "standard_charge_percentage": 53.2000, "estimated_amount": 958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 394.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 394, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1441.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1441, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Treat Wnd Dehiscence, Simple Closure", "code_information": [ { "code": "12020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1131, "discounted_cash": 829,"minimum": 226.2,"maximum": 1131,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 311.02, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 797.61, "estimated_amount": 797, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 904.8, "standard_charge_percentage": 80.0000, "estimated_amount": 904, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 309.61, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 904.8, "standard_charge_percentage": 80.0000, "estimated_amount": 904, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 904.8, "standard_charge_percentage": 80.0000, "estimated_amount": 904, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 606.19, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 904.8, "standard_charge_percentage": 80.0000, "estimated_amount": 904, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 989.04, "estimated_amount": 989, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 339.3, "standard_charge_percentage": 30.0000, "estimated_amount": 339, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 733.8, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 247.69, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 247, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 957.13, "estimated_amount": 957, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1131, "estimated_amount": 1131, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 309.61, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 989.04, "estimated_amount": 989, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 861.42, "estimated_amount": 861, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 247.69, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 247, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 803.01, "standard_charge_percentage": 71.0000, "estimated_amount": 803, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 893.33, "estimated_amount": 893, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 765.71, "estimated_amount": 765, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 426.01, "estimated_amount": 426, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 435.17, "estimated_amount": 435, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 938.73, "standard_charge_percentage": 83.0000, "estimated_amount": 938, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 458.07, "estimated_amount": 458, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 295.19, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 295, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 791.7, "standard_charge_percentage": 70.0000, "estimated_amount": 791, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 701.9, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 625.33, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1033.71, "estimated_amount": 1033, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 247.69, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 247, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 226.2, "standard_charge_percentage": 20.0000, "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1131, "estimated_amount": 1131, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 735.15, "standard_charge_percentage": 65.0000, "estimated_amount": 735, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 848.25, "standard_charge_percentage": 75.0000, "estimated_amount": 848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 384.54, "standard_charge_percentage": 34.0000, "estimated_amount": 384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 904.8, "standard_charge_percentage": 80.0000, "estimated_amount": 904, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1131, "estimated_amount": 1131, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1131, "estimated_amount": 1131, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" }]}]} , { "description": "Intmd rpr satext 2.5 cm<", "code_information": [ { "code": "12031", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2416.66, "discounted_cash": 541,"minimum": 265.46,"maximum": 2416.66,"payers_information":[{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1933.33, "standard_charge_percentage": 80.0000, "estimated_amount": 1933, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 435.17, "estimated_amount": 435, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 2005.83, "standard_charge_percentage": 83.0000, "estimated_amount": 2005, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1933.33, "standard_charge_percentage": 80.0000, "estimated_amount": 1933, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1715.83, "standard_charge_percentage": 71.0000, "estimated_amount": 1715, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 949.88, "estimated_amount": 949, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 674.68, "estimated_amount": 674, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 529.25, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1812.49, "standard_charge_percentage": 75.0000, "estimated_amount": 1812, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 630.75, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 630, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1933.33, "standard_charge_percentage": 80.0000, "estimated_amount": 1933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 265.46, "estimated_amount": 265, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 821.66, "standard_charge_percentage": 34.0000, "estimated_amount": 821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 725, "standard_charge_percentage": 30.0000, "estimated_amount": 725, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 604.16, "standard_charge_percentage": 25.0000, "estimated_amount": 604, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 529.25, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1691.66, "standard_charge_percentage": 70.0000, "estimated_amount": 1691, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1570.83, "standard_charge_percentage": 65.0000, "estimated_amount": 1570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1933.33, "standard_charge_percentage": 80.0000, "estimated_amount": 1933, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 426.01, "estimated_amount": 426, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 265.46, "estimated_amount": 265, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 773.33, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 773, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 483.33, "standard_charge_percentage": 20.0000, "estimated_amount": 483, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 529.25, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1933.33, "standard_charge_percentage": 80.0000, "estimated_amount": 1933, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 664.58, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 664, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 458.07, "estimated_amount": 458, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 2416.66, "estimated_amount": 2416, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" }]}]} , { "description": "Intmd rpr satext 2.6-7.5", "code_information": [ { "code": "12032", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1067, "discounted_cash": 541,"minimum": 213.4,"maximum": 1067,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 853.6, "standard_charge_percentage": 80.0000, "estimated_amount": 853, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 757.57, "standard_charge_percentage": 71.0000, "estimated_amount": 757, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 853.6, "standard_charge_percentage": 80.0000, "estimated_amount": 853, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 674.68, "estimated_amount": 674, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 233.67, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 233, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 885.61, "standard_charge_percentage": 83.0000, "estimated_amount": 885, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 853.6, "standard_charge_percentage": 80.0000, "estimated_amount": 853, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 293.43, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 293, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 308.82, "estimated_amount": 308, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 266.75, "standard_charge_percentage": 25.0000, "estimated_amount": 266, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 746.9, "standard_charge_percentage": 70.0000, "estimated_amount": 746, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1067, "estimated_amount": 1067, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 800.25, "standard_charge_percentage": 75.0000, "estimated_amount": 800, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 233.67, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 233, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 213.4, "standard_charge_percentage": 20.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 308.82, "estimated_amount": 308, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 320.1, "standard_charge_percentage": 30.0000, "estimated_amount": 320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 435.17, "estimated_amount": 435, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 426.01, "estimated_amount": 426, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 233.67, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 233, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 278.49, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 853.6, "standard_charge_percentage": 80.0000, "estimated_amount": 853, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 949.88, "estimated_amount": 949, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 853.6, "standard_charge_percentage": 80.0000, "estimated_amount": 853, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 458.07, "estimated_amount": 458, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 362.78, "standard_charge_percentage": 34.0000, "estimated_amount": 362, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 693.55, "standard_charge_percentage": 65.0000, "estimated_amount": 693, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 341.44, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 341, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1067, "estimated_amount": 1067, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" }]}]} , { "description": "Intmd rpr strext 7.6-12.5", "code_information": [ { "code": "12034", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1299, "discounted_cash": 541,"minimum": 259.8,"maximum": 1299,"payers_information":[{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 284.48, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 284, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 284.48, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 284, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 844.35, "standard_charge_percentage": 65.0000, "estimated_amount": 844, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 341.59, "estimated_amount": 341, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 974.25, "standard_charge_percentage": 75.0000, "estimated_amount": 974, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 341.59, "estimated_amount": 341, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1299, "estimated_amount": 1299, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 1078.17, "standard_charge_percentage": 83.0000, "estimated_amount": 1078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1039.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1039, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 435.17, "estimated_amount": 435, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 909.3, "standard_charge_percentage": 70.0000, "estimated_amount": 909, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 339.04, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 339, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 426.01, "estimated_amount": 426, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 259.8, "standard_charge_percentage": 20.0000, "estimated_amount": 259, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 949.88, "estimated_amount": 949, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 674.68, "estimated_amount": 674, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 357.23, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 357, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 389.7, "standard_charge_percentage": 30.0000, "estimated_amount": 389, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 284.48, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 284, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1299, "estimated_amount": 1299, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1039.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1039, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1039.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1039, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1039.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1039, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 458.07, "estimated_amount": 458, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 922.29, "standard_charge_percentage": 71.0000, "estimated_amount": 922, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1039.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1039, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 441.66, "standard_charge_percentage": 34.0000, "estimated_amount": 441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1299, "estimated_amount": 1299, "methodology": "case rate" }]}]} , { "description": "Intmd rpr satext 12.6-20", "code_information": [ { "code": "12035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1602, "discounted_cash": 541,"minimum": 320.4,"maximum": 1602,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 350.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 350, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1281.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1281.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 674.68, "estimated_amount": 674, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1602, "estimated_amount": 1602, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 949.88, "estimated_amount": 949, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 458.07, "estimated_amount": 458, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 435.17, "estimated_amount": 435, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 320.4, "standard_charge_percentage": 20.0000, "estimated_amount": 320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 480.6, "standard_charge_percentage": 30.0000, "estimated_amount": 480, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 544.68, "standard_charge_percentage": 34.0000, "estimated_amount": 544, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1602, "estimated_amount": 1602, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 350.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 350, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1121.4, "standard_charge_percentage": 70.0000, "estimated_amount": 1121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1041.3, "standard_charge_percentage": 65.0000, "estimated_amount": 1041, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 1329.66, "standard_charge_percentage": 83.0000, "estimated_amount": 1329, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 440.55, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 440, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1201.5, "standard_charge_percentage": 75.0000, "estimated_amount": 1201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 426.01, "estimated_amount": 426, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1281.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 404.96, "estimated_amount": 404, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 404.96, "estimated_amount": 404, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1137.42, "standard_charge_percentage": 71.0000, "estimated_amount": 1137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 350.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 350, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1281.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1281, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 418.12, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 418, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1281.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1281, "methodology": "percent of total billed charges" }]}]} , { "description": "Intmd rpr n-hfgenit 2.5cm<", "code_information": [ { "code": "12041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1998, "discounted_cash": 541,"minimum": 267.69,"maximum": 1998,"payers_information":[{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 1658.34, "standard_charge_percentage": 83.0000, "estimated_amount": 1658, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 521.48, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 521, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1598.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1598, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1398.6, "standard_charge_percentage": 70.0000, "estimated_amount": 1398, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 267.69, "estimated_amount": 267, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 437.56, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 437, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1009.79, "standard_charge_percentage": 53.2000, "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 549.45, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 679.32, "standard_charge_percentage": 34.0000, "estimated_amount": 679, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 499.5, "standard_charge_percentage": 25.0000, "estimated_amount": 499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1998, "estimated_amount": 1998, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1298.7, "standard_charge_percentage": 65.0000, "estimated_amount": 1298, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1062.94, "standard_charge_percentage": 53.2000, "estimated_amount": 1062, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1598.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1598, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1598.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1598, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 267.69, "estimated_amount": 267, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1598.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1598, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 399.6, "standard_charge_percentage": 20.0000, "estimated_amount": 399, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 437.56, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 437, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 437.56, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 437, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1418.58, "standard_charge_percentage": 71.0000, "estimated_amount": 1418, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1598.4, "standard_charge_percentage": 80.0000, "estimated_amount": 1598, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 639.36, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 639, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 949.88, "estimated_amount": 949, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 988.53, "standard_charge_percentage": 53.2000, "estimated_amount": 988, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1498.5, "standard_charge_percentage": 75.0000, "estimated_amount": 1498, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 599.4, "standard_charge_percentage": 30.0000, "estimated_amount": 599, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 674.68, "estimated_amount": 674, "methodology": "fee schedule" }]}]} , { "description": "Intmd rpr n-hfgenit2.6-7.5", "code_information": [ { "code": "12042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 597, "discounted_cash": 541,"minimum": 119.4,"maximum": 597,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 447.75, "standard_charge_percentage": 75.0000, "estimated_amount": 447, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 597, "estimated_amount": 597, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 597, "estimated_amount": 597, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 477.6, "standard_charge_percentage": 80.0000, "estimated_amount": 477, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 423.87, "standard_charge_percentage": 71.0000, "estimated_amount": 423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 435.17, "estimated_amount": 435, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 597, "estimated_amount": 597, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 179.1, "standard_charge_percentage": 30.0000, "estimated_amount": 179, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 315.59, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 315.59, "estimated_amount": 315, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 130.74, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 191.04, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 119.4, "standard_charge_percentage": 20.0000, "estimated_amount": 119, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 477.6, "standard_charge_percentage": 80.0000, "estimated_amount": 477, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 164.18, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 597, "estimated_amount": 597, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 155.82, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 155, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 477.6, "standard_charge_percentage": 80.0000, "estimated_amount": 477, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 149.25, "standard_charge_percentage": 25.0000, "estimated_amount": 149, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 426.01, "estimated_amount": 426, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 477.6, "standard_charge_percentage": 80.0000, "estimated_amount": 477, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 495.51, "standard_charge_percentage": 83.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 597, "estimated_amount": 597, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 597, "estimated_amount": 597, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 458.07, "estimated_amount": 458, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 597, "estimated_amount": 597, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 417.9, "standard_charge_percentage": 70.0000, "estimated_amount": 417, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 202.98, "standard_charge_percentage": 34.0000, "estimated_amount": 202, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 477.6, "standard_charge_percentage": 80.0000, "estimated_amount": 477, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 130.74, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 130.74, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 388.05, "standard_charge_percentage": 65.0000, "estimated_amount": 388, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Repr Wnd Intrmd Face <2.5 Cm", "code_information": [ { "code": "12051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 597, "discounted_cash": 541,"minimum": 119.4,"maximum": 16025.6,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 477.6, "standard_charge_percentage": 80.0000, "estimated_amount": 477, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 13708.7, "standard_charge_percentage": 71.0000, "estimated_amount": 13708, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 191.04, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 15446.4, "standard_charge_percentage": 80.0000, "estimated_amount": 15446, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 287.08, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 287.08, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5792.4, "standard_charge_percentage": 30.0000, "estimated_amount": 5792, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 597, "estimated_amount": 597, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3861.6, "standard_charge_percentage": 20.0000, "estimated_amount": 3861, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 130.74, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 477.6, "standard_charge_percentage": 80.0000, "estimated_amount": 477, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15446.4, "standard_charge_percentage": 80.0000, "estimated_amount": 15446, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 149.25, "standard_charge_percentage": 25.0000, "estimated_amount": 149, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 4827, "standard_charge_percentage": 25.0000, "estimated_amount": 4827, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 597, "estimated_amount": 597, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 435.17, "estimated_amount": 435, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 130.74, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 155.82, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 15446.4, "standard_charge_percentage": 80.0000, "estimated_amount": 15446, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 495.51, "standard_charge_percentage": 83.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 388.05, "standard_charge_percentage": 65.0000, "estimated_amount": 388, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 287.08, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 202.98, "standard_charge_percentage": 34.0000, "estimated_amount": 202, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 16025.6, "standard_charge_percentage": 83.0000, "estimated_amount": 16025, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 130.74, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 130, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 949.88, "estimated_amount": 949, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 477.6, "standard_charge_percentage": 80.0000, "estimated_amount": 477, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 447.75, "standard_charge_percentage": 75.0000, "estimated_amount": 447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 597, "estimated_amount": 597, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 13515.6, "standard_charge_percentage": 70.0000, "estimated_amount": 13515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 12550.2, "standard_charge_percentage": 65.0000, "estimated_amount": 12550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 597, "estimated_amount": 597, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 179.1, "standard_charge_percentage": 30.0000, "estimated_amount": 179, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 423.87, "standard_charge_percentage": 71.0000, "estimated_amount": 423, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 426.01, "estimated_amount": 426, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 597, "estimated_amount": 597, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 435.17, "estimated_amount": 435, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 458.07, "estimated_amount": 458, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 164.18, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 6564.72, "standard_charge_percentage": 34.0000, "estimated_amount": 6564, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 4228.45, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 4228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 119.4, "standard_charge_percentage": 20.0000, "estimated_amount": 119, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 477.6, "standard_charge_percentage": 80.0000, "estimated_amount": 477, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 4228.45, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 4228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 287.08, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5039.39, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5039, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 597, "estimated_amount": 597, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 6178.56, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 6178, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 4228.45, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 4228, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 426.01, "estimated_amount": 426, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 458.07, "estimated_amount": 458, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 477.6, "standard_charge_percentage": 80.0000, "estimated_amount": 477, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 14481, "standard_charge_percentage": 75.0000, "estimated_amount": 14481, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15446.4, "standard_charge_percentage": 80.0000, "estimated_amount": 15446, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 674.68, "estimated_amount": 674, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 597, "estimated_amount": 597, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 15446.4, "standard_charge_percentage": 80.0000, "estimated_amount": 15446, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 417.9, "standard_charge_percentage": 70.0000, "estimated_amount": 417, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 5309.7, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 5309, "methodology": "percent of total billed charges" }]}]} , { "description": "Intmd rpr face/mm 2.6-5.0 cm", "code_information": [ { "code": "12052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12232, "discounted_cash": 541,"minimum": 132.2,"maximum": 10152.6,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9785.6, "standard_charge_percentage": 80.0000, "estimated_amount": 9785, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9785.6, "standard_charge_percentage": 80.0000, "estimated_amount": 9785, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 528.8, "standard_charge_percentage": 80.0000, "estimated_amount": 528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 211.52, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 211, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4158.88, "standard_charge_percentage": 34.0000, "estimated_amount": 4158, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 674.68, "estimated_amount": 674, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 661, "estimated_amount": 661, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 181.78, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 181, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 9785.6, "standard_charge_percentage": 80.0000, "estimated_amount": 9785, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 321.49, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 165.25, "standard_charge_percentage": 25.0000, "estimated_amount": 165, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 458.07, "estimated_amount": 458, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 661, "estimated_amount": 661, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3669.6, "standard_charge_percentage": 30.0000, "estimated_amount": 3669, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 321.49, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 426.01, "estimated_amount": 426, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 435.17, "estimated_amount": 435, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 528.8, "standard_charge_percentage": 80.0000, "estimated_amount": 528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 3058, "standard_charge_percentage": 25.0000, "estimated_amount": 3058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 144.76, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 144, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 8562.4, "standard_charge_percentage": 70.0000, "estimated_amount": 8562, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 528.8, "standard_charge_percentage": 80.0000, "estimated_amount": 528, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 144.76, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 144, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 321.49, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3914.24, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 3914, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 458.07, "estimated_amount": 458, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2678.81, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2678, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10152.6, "standard_charge_percentage": 83.0000, "estimated_amount": 10152, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3192.55, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 435.17, "estimated_amount": 435, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 528.8, "standard_charge_percentage": 80.0000, "estimated_amount": 528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9174, "standard_charge_percentage": 75.0000, "estimated_amount": 9174, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 144.76, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 144, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3363.8, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3363, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 321.49, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7950.8, "standard_charge_percentage": 65.0000, "estimated_amount": 7950, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 548.63, "standard_charge_percentage": 83.0000, "estimated_amount": 548, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2678.81, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2678, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 198.3, "standard_charge_percentage": 30.0000, "estimated_amount": 198, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 949.88, "estimated_amount": 949, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 172.52, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2446.4, "standard_charge_percentage": 20.0000, "estimated_amount": 2446, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 429.65, "standard_charge_percentage": 65.0000, "estimated_amount": 429, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 224.74, "standard_charge_percentage": 34.0000, "estimated_amount": 224, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 426.01, "estimated_amount": 426, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 8684.72, "standard_charge_percentage": 71.0000, "estimated_amount": 8684, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 469.31, "standard_charge_percentage": 71.0000, "estimated_amount": 469, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 132.2, "standard_charge_percentage": 20.0000, "estimated_amount": 132, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 9785.6, "standard_charge_percentage": 80.0000, "estimated_amount": 9785, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 9785.6, "standard_charge_percentage": 80.0000, "estimated_amount": 9785, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 528.8, "standard_charge_percentage": 80.0000, "estimated_amount": 528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 661, "estimated_amount": 661, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2678.81, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2678, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 462.7, "standard_charge_percentage": 70.0000, "estimated_amount": 462, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 661, "estimated_amount": 661, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 495.75, "standard_charge_percentage": 75.0000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" }]}]} , { "description": "Hc Repr Wnd Intrmd Face 5.1-7.5 Cm", "code_information": [ { "code": "12053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 860, "discounted_cash": 541,"minimum": 172,"maximum": 860,"payers_information":[{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 688, "standard_charge_percentage": 80.0000, "estimated_amount": 688, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 688, "standard_charge_percentage": 80.0000, "estimated_amount": 688, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 188.34, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 188, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 426.01, "estimated_amount": 426, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 258, "standard_charge_percentage": 30.0000, "estimated_amount": 258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 172, "standard_charge_percentage": 20.0000, "estimated_amount": 172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 688, "standard_charge_percentage": 80.0000, "estimated_amount": 688, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 645, "standard_charge_percentage": 75.0000, "estimated_amount": 645, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 860, "estimated_amount": 860, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 458.07, "estimated_amount": 458, "methodology": "case rate" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 275.2, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 275, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 610.6, "standard_charge_percentage": 71.0000, "estimated_amount": 610, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 224.46, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 224, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 688, "standard_charge_percentage": 80.0000, "estimated_amount": 688, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 435.17, "estimated_amount": 435, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 369.28, "estimated_amount": 369, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 292.4, "standard_charge_percentage": 34.0000, "estimated_amount": 292, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 860, "estimated_amount": 860, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 559, "standard_charge_percentage": 65.0000, "estimated_amount": 559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 369.28, "estimated_amount": 369, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 236.5, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 688, "standard_charge_percentage": 80.0000, "estimated_amount": 688, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 215, "standard_charge_percentage": 25.0000, "estimated_amount": 215, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 188.34, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 188, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 674.68, "estimated_amount": 674, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 713.8, "standard_charge_percentage": 83.0000, "estimated_amount": 713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 188.34, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 188, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 602, "standard_charge_percentage": 70.0000, "estimated_amount": 602, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 860, "estimated_amount": 860, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "13101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7044, "discounted_cash": 829,"minimum": 402.16,"maximum": 5846.52,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1937.1, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 765.71, "estimated_amount": 765, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4930.8, "standard_charge_percentage": 70.0000, "estimated_amount": 4930, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1542.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1542, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 989.04, "estimated_amount": 989, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5283, "standard_charge_percentage": 75.0000, "estimated_amount": 5283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 861.42, "estimated_amount": 861, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 893.33, "estimated_amount": 893, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 701.9, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1033.71, "estimated_amount": 1033, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1542.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 957.13, "estimated_amount": 957, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1408.8, "standard_charge_percentage": 20.0000, "estimated_amount": 1408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 606.19, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1542.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1542, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 402.16, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4578.6, "standard_charge_percentage": 65.0000, "estimated_amount": 4578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1541.96, "estimated_amount": 1541, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1455.36, "estimated_amount": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 402.16, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1509.5, "estimated_amount": 1509, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1623.12, "estimated_amount": 1623, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2394.96, "standard_charge_percentage": 34.0000, "estimated_amount": 2394, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 989.04, "estimated_amount": 989, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5846.52, "standard_charge_percentage": 83.0000, "estimated_amount": 5846, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1838.48, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1838, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 733.8, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 625.33, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2113.2, "standard_charge_percentage": 30.0000, "estimated_amount": 2113, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 5001.24, "standard_charge_percentage": 71.0000, "estimated_amount": 5001, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 797.61, "estimated_amount": 797, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "13102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7044,"minimum": 120.62,"maximum": 5846.52,"payers_information":[{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1761, "standard_charge_percentage": 25.0000, "estimated_amount": 1761, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3560.04, "standard_charge_percentage": 53.2000, "estimated_amount": 3560, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 120.62, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1542.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2113.2, "standard_charge_percentage": 30.0000, "estimated_amount": 2113, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1542.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2254.08, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2254, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1838.48, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1838, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1408.8, "standard_charge_percentage": 20.0000, "estimated_amount": 1408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5846.52, "standard_charge_percentage": 83.0000, "estimated_amount": 5846, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1937.1, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 3485.09, "standard_charge_percentage": 53.2000, "estimated_amount": 3485, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1542.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2394.96, "standard_charge_percentage": 34.0000, "estimated_amount": 2394, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5283, "standard_charge_percentage": 75.0000, "estimated_amount": 5283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 5001.24, "standard_charge_percentage": 71.0000, "estimated_amount": 5001, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 120.62, "estimated_amount": 120, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 3747.41, "standard_charge_percentage": 53.2000, "estimated_amount": 3747, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4930.8, "standard_charge_percentage": 70.0000, "estimated_amount": 4930, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4578.6, "standard_charge_percentage": 65.0000, "estimated_amount": 4578, "methodology": "percent of total billed charges" }]}]} , { "description": "Cmplx rpr sal 2.6-7.5 cm", "code_information": [ { "code": "13121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5346, "discounted_cash": 829,"minimum": 426.01,"maximum": 4550,"payers_information":[{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 989.04, "estimated_amount": 989, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 733.8, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1817.64, "standard_charge_percentage": 34.0000, "estimated_amount": 1817, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 797.61, "estimated_amount": 797, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 625.33, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3795.66, "standard_charge_percentage": 71.0000, "estimated_amount": 3795, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4276.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4276, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4009.5, "standard_charge_percentage": 75.0000, "estimated_amount": 4009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 435.17, "estimated_amount": 435, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1170.77, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1170, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 861.42, "estimated_amount": 861, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 432.63, "estimated_amount": 432, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 957.13, "estimated_amount": 957, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4276.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4276, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1455.36, "estimated_amount": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 606.19, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3742.2, "standard_charge_percentage": 70.0000, "estimated_amount": 3742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 426.01, "estimated_amount": 426, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1395.31, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1395, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1170.77, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1170, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4276.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4276, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4276.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4276, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1170.77, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1170, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 989.04, "estimated_amount": 989, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 765.71, "estimated_amount": 765, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4276.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4276, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 432.63, "estimated_amount": 432, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1603.8, "standard_charge_percentage": 30.0000, "estimated_amount": 1603, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 4437.18, "standard_charge_percentage": 83.0000, "estimated_amount": 4437, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 701.9, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 458.07, "estimated_amount": 458, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3474.9, "standard_charge_percentage": 65.0000, "estimated_amount": 3474, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1470.15, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1470, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1033.71, "estimated_amount": 1033, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 893.33, "estimated_amount": 893, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1069.2, "standard_charge_percentage": 20.0000, "estimated_amount": 1069, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "13122", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5346,"minimum": 130.76,"maximum": 4550,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1170.77, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1170, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4276.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4276, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3742.2, "standard_charge_percentage": 70.0000, "estimated_amount": 3742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1069.2, "standard_charge_percentage": 20.0000, "estimated_amount": 1069, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1336.5, "standard_charge_percentage": 25.0000, "estimated_amount": 1336, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 4437.18, "standard_charge_percentage": 83.0000, "estimated_amount": 4437, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 130.76, "estimated_amount": 130, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4276.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4276, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1603.8, "standard_charge_percentage": 30.0000, "estimated_amount": 1603, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1170.77, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1170, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4009.5, "standard_charge_percentage": 75.0000, "estimated_amount": 4009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3795.66, "standard_charge_percentage": 71.0000, "estimated_amount": 3795, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1470.15, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1470, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 130.76, "estimated_amount": 130, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1817.64, "standard_charge_percentage": 34.0000, "estimated_amount": 1817, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2844.07, "standard_charge_percentage": 53.2000, "estimated_amount": 2844, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4276.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4276, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1170.77, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1170, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 2644.99, "standard_charge_percentage": 53.2000, "estimated_amount": 2644, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4276.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4276, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 2701.87, "standard_charge_percentage": 53.2000, "estimated_amount": 2701, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1395.31, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1395, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3474.9, "standard_charge_percentage": 65.0000, "estimated_amount": 3474, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1710.72, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 1710, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4276.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4276, "methodology": "percent of total billed charges" }]}]} , { "description": "Cmplx rpr fccmnaxghf", "code_information": [ { "code": "13131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4195.58, "discounted_cash": 541,"minimum": 395.65,"maximum": 4195.58,"payers_information":[{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3356.46, "standard_charge_percentage": 80.0000, "estimated_amount": 3356, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 645.53, "estimated_amount": 645, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 583.06, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 839.12, "standard_charge_percentage": 20.0000, "estimated_amount": 839, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 918.83, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3482.33, "standard_charge_percentage": 83.0000, "estimated_amount": 3482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 458.07, "estimated_amount": 458, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 478.94, "estimated_amount": 478, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1095.05, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1095, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 918.83, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 624.71, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3356.46, "standard_charge_percentage": 80.0000, "estimated_amount": 3356, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1153.78, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 458.12, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 562.23, "estimated_amount": 562, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2727.13, "standard_charge_percentage": 65.0000, "estimated_amount": 2727, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 396.71, "estimated_amount": 396, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 395.65, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 426.01, "estimated_amount": 426, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 396.71, "estimated_amount": 396, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2978.86, "standard_charge_percentage": 71.0000, "estimated_amount": 2978, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3146.68, "standard_charge_percentage": 75.0000, "estimated_amount": 3146, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 918.83, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 918, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3356.46, "standard_charge_percentage": 80.0000, "estimated_amount": 3356, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1426.5, "standard_charge_percentage": 34.0000, "estimated_amount": 1426, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 437.29, "estimated_amount": 437, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3356.46, "standard_charge_percentage": 80.0000, "estimated_amount": 3356, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 408.14, "estimated_amount": 408, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1258.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2936.91, "standard_charge_percentage": 70.0000, "estimated_amount": 2936, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 520.59, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 499.76, "estimated_amount": 499, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 428.96, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 435.17, "estimated_amount": 435, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 949.88, "estimated_amount": 949, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 416.47, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4195.58, "estimated_amount": 4195, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3356.46, "standard_charge_percentage": 80.0000, "estimated_amount": 3356, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 674.68, "estimated_amount": 674, "methodology": "fee schedule" }]}]} , { "description": "Sec clsr surg wnddehsn xtn", "code_information": [ { "code": "13160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9298, "discounted_cash": 2478,"minimum": 488,"maximum": 7717.34,"payers_information":[{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2556.95, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6283.01, "estimated_amount": 6283, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1339.11, "estimated_amount": 1339, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 7438.4, "standard_charge_percentage": 80.0000, "estimated_amount": 7438, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 7438.4, "standard_charge_percentage": 80.0000, "estimated_amount": 7438, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6613.7, "estimated_amount": 6613, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 7438.4, "standard_charge_percentage": 80.0000, "estimated_amount": 7438, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2036.26, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2036, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7717.34, "standard_charge_percentage": 83.0000, "estimated_amount": 7717, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1859.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1859, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7438.4, "standard_charge_percentage": 80.0000, "estimated_amount": 7438, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 2192.84, "estimated_amount": 2192, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2383.53, "estimated_amount": 2383, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 6043.7, "standard_charge_percentage": 65.0000, "estimated_amount": 6043, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2288.18, "estimated_amount": 2288, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 858.21, "estimated_amount": 858, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2036.26, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2036, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 6150.74, "estimated_amount": 6150, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6508.6, "standard_charge_percentage": 70.0000, "estimated_amount": 6508, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2860.23, "estimated_amount": 2860, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2574.21, "estimated_amount": 2574, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1811.48, "estimated_amount": 1811, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 858.21, "estimated_amount": 858, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6973.5, "standard_charge_percentage": 75.0000, "estimated_amount": 6973, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1339.11, "estimated_amount": 1339, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1868.68, "estimated_amount": 1868, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2036.26, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2036, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 2097.5, "estimated_amount": 2097, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2669.55, "estimated_amount": 2669, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3161.32, "standard_charge_percentage": 34.0000, "estimated_amount": 3161, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7438.4, "standard_charge_percentage": 80.0000, "estimated_amount": 7438, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2789.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 3089.05, "estimated_amount": 3089, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6601.58, "standard_charge_percentage": 71.0000, "estimated_amount": 6601, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2426.78, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2426, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 4349.08, "estimated_amount": 4349, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" }]}]} , { "description": "Tis trnfr fccmnaghf", "code_information": [ { "code": "14040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7713, "discounted_cash": 2478,"minimum": 488,"maximum": 6401.79,"payers_information":[{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 3089.05, "estimated_amount": 3089, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1689.15, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1689, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6170.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6170, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1811.48, "estimated_amount": 1811, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2669.55, "estimated_amount": 2669, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5013.45, "standard_charge_percentage": 65.0000, "estimated_amount": 5013, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6170.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6170, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5784.75, "standard_charge_percentage": 75.0000, "estimated_amount": 5784, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4028.09, "estimated_amount": 4028, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6170.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6170, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4331.28, "estimated_amount": 4331, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1542.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2121.07, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2121, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 5476.23, "standard_charge_percentage": 71.0000, "estimated_amount": 5476, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6170.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6170, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6170.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6170, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 793.02, "estimated_amount": 793, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2313.9, "standard_charge_percentage": 30.0000, "estimated_amount": 2313, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5399.1, "standard_charge_percentage": 70.0000, "estimated_amount": 5399, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2288.18, "estimated_amount": 2288, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 6401.79, "standard_charge_percentage": 83.0000, "estimated_amount": 6401, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 2097.5, "estimated_amount": 2097, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2013.09, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2013, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2574.21, "estimated_amount": 2574, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2860.23, "estimated_amount": 2860, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 4349.08, "estimated_amount": 4349, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2622.42, "standard_charge_percentage": 34.0000, "estimated_amount": 2622, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2383.53, "estimated_amount": 2383, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1868.68, "estimated_amount": 1868, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1689.15, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 793.02, "estimated_amount": 793, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4114.72, "estimated_amount": 4114, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 2192.84, "estimated_amount": 2192, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1689.15, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" }]}]} , { "description": "Tis trnfr enel 10 sq cm<", "code_information": [ { "code": "14060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5856.45, "discounted_cash": 2478,"minimum": 558,"maximum": 4860.85,"payers_information":[{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4685.16, "standard_charge_percentage": 80.0000, "estimated_amount": 4685, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 2192.84, "estimated_amount": 2192, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2383.53, "estimated_amount": 2383, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4099.52, "standard_charge_percentage": 70.0000, "estimated_amount": 4099, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1528.53, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2288.18, "estimated_amount": 2288, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1282.56, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1282, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4685.16, "standard_charge_percentage": 80.0000, "estimated_amount": 4685, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 4860.85, "standard_charge_percentage": 83.0000, "estimated_amount": 4860, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1991.19, "standard_charge_percentage": 34.0000, "estimated_amount": 1991, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 800.29, "estimated_amount": 800, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 4349.08, "estimated_amount": 4349, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2574.21, "estimated_amount": 2574, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4331.28, "estimated_amount": 4331, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 3089.05, "estimated_amount": 3089, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4028.09, "estimated_amount": 4028, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2669.55, "estimated_amount": 2669, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 2097.5, "estimated_amount": 2097, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1811.48, "estimated_amount": 1811, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1756.93, "standard_charge_percentage": 30.0000, "estimated_amount": 1756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1868.68, "estimated_amount": 1868, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1282.56, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1282, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4114.72, "estimated_amount": 4114, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2860.23, "estimated_amount": 2860, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4685.16, "standard_charge_percentage": 80.0000, "estimated_amount": 4685, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 800.29, "estimated_amount": 800, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1171.29, "standard_charge_percentage": 20.0000, "estimated_amount": 1171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4685.16, "standard_charge_percentage": 80.0000, "estimated_amount": 4685, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1282.56, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1282, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3806.69, "standard_charge_percentage": 65.0000, "estimated_amount": 3806, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4392.34, "standard_charge_percentage": 75.0000, "estimated_amount": 4392, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4685.16, "standard_charge_percentage": 80.0000, "estimated_amount": 4685, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1610.52, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1610, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4158.08, "standard_charge_percentage": 71.0000, "estimated_amount": 4158, "methodology": "percent of total billed charges" }]}]} , { "description": "Tis trnfr any 30.1-60 sq cm", "code_information": [ { "code": "14301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7044, "discounted_cash": 4961,"minimum": 1140.16,"maximum": 7044,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4770.32, "estimated_amount": 4770, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5846.52, "standard_charge_percentage": 83.0000, "estimated_amount": 5846, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3930.75, "estimated_amount": 3930, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1408.8, "standard_charge_percentage": 20.0000, "estimated_amount": 1408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3739.93, "estimated_amount": 3739, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1467, "estimated_amount": 1467, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1838.48, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1838, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5283, "standard_charge_percentage": 75.0000, "estimated_amount": 5283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3930.75, "estimated_amount": 3930, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7044, "estimated_amount": 7044, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 4197.89, "estimated_amount": 4197, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5915.2, "estimated_amount": 5915, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 5342.76, "estimated_amount": 5342, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 5001.24, "standard_charge_percentage": 71.0000, "estimated_amount": 5001, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1140.16, "estimated_amount": 1140, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 4007.07, "estimated_amount": 4007, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4930.8, "standard_charge_percentage": 70.0000, "estimated_amount": 4930, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1542.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1542, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 5151.95, "estimated_amount": 5151, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3625.45, "estimated_amount": 3625, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3560.04, "standard_charge_percentage": 53.2000, "estimated_amount": 3560, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 6182.34, "estimated_amount": 6182, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2394.96, "standard_charge_percentage": 34.0000, "estimated_amount": 2394, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 4007.07, "estimated_amount": 4007, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4579.51, "estimated_amount": 4579, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5724.39, "estimated_amount": 5724, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3930.75, "estimated_amount": 3930, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4578.6, "standard_charge_percentage": 65.0000, "estimated_amount": 4578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 4007.07, "estimated_amount": 4007, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1542.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 4007.07, "estimated_amount": 4007, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2113.2, "standard_charge_percentage": 30.0000, "estimated_amount": 2113, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1140.16, "estimated_amount": 1140, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5915.2, "estimated_amount": 5915, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1542.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2254.08, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2254, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 3485.09, "standard_charge_percentage": 53.2000, "estimated_amount": 3485, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 4388.7, "estimated_amount": 4388, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 3747.41, "standard_charge_percentage": 53.2000, "estimated_amount": 3747, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1937.1, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1937, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "14302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7044,"minimum": 232.08,"maximum": 5846.52,"payers_information":[{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 232.08, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4930.8, "standard_charge_percentage": 70.0000, "estimated_amount": 4930, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2113.2, "standard_charge_percentage": 30.0000, "estimated_amount": 2113, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1542.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1542, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1542.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2394.96, "standard_charge_percentage": 34.0000, "estimated_amount": 2394, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1937.1, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4578.6, "standard_charge_percentage": 65.0000, "estimated_amount": 4578, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2254.08, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2254, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 232.08, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1408.8, "standard_charge_percentage": 20.0000, "estimated_amount": 1408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 3747.41, "standard_charge_percentage": 53.2000, "estimated_amount": 3747, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3560.04, "standard_charge_percentage": 53.2000, "estimated_amount": 3560, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5846.52, "standard_charge_percentage": 83.0000, "estimated_amount": 5846, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1838.48, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1838, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5283, "standard_charge_percentage": 75.0000, "estimated_amount": 5283, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5635.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5635, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 3485.09, "standard_charge_percentage": 53.2000, "estimated_amount": 3485, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 5001.24, "standard_charge_percentage": 71.0000, "estimated_amount": 5001, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1761, "standard_charge_percentage": 25.0000, "estimated_amount": 1761, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1542.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "14350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12248, "discounted_cash": 2478,"minimum": 558,"maximum": 10165.8,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2682.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2574.21, "estimated_amount": 2574, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3368.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3368, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9798.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9798, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 9798.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9798, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3674.4, "standard_charge_percentage": 30.0000, "estimated_amount": 3674, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2288.18, "estimated_amount": 2288, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9186, "standard_charge_percentage": 75.0000, "estimated_amount": 9186, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4164.32, "standard_charge_percentage": 34.0000, "estimated_amount": 4164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 2192.84, "estimated_amount": 2192, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2682.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7961.2, "standard_charge_percentage": 65.0000, "estimated_amount": 7961, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2383.53, "estimated_amount": 2383, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 4349.08, "estimated_amount": 4349, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 6150.74, "estimated_amount": 6150, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1811.48, "estimated_amount": 1811, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2449.6, "standard_charge_percentage": 20.0000, "estimated_amount": 2449, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 9798.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9798, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2682.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10165.8, "standard_charge_percentage": 83.0000, "estimated_amount": 10165, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3196.73, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3196, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2669.55, "estimated_amount": 2669, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1868.68, "estimated_amount": 1868, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 693.53, "estimated_amount": 693, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 9798.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9798, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 2097.5, "estimated_amount": 2097, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6283.01, "estimated_amount": 6283, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6613.7, "estimated_amount": 6613, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9798.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9798, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 693.53, "estimated_amount": 693, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 8696.08, "standard_charge_percentage": 71.0000, "estimated_amount": 8696, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2860.23, "estimated_amount": 2860, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 8573.6, "standard_charge_percentage": 70.0000, "estimated_amount": 8573, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 3089.05, "estimated_amount": 3089, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" }]}]} , { "description": "Wound prep trkarmleg", "code_information": [ { "code": "15002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6791.16, "discounted_cash": 2478,"minimum": 357.88,"maximum": 5636.66,"payers_information":[{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2037.35, "standard_charge_percentage": 30.0000, "estimated_amount": 2037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2860.23, "estimated_amount": 2860, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 3089.05, "estimated_amount": 3089, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1339.11, "estimated_amount": 1339, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2669.55, "estimated_amount": 2669, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1772.49, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 2192.84, "estimated_amount": 2192, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1811.48, "estimated_amount": 1811, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1487.26, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1487, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5636.66, "standard_charge_percentage": 83.0000, "estimated_amount": 5636, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5432.93, "standard_charge_percentage": 80.0000, "estimated_amount": 5432, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4414.25, "standard_charge_percentage": 65.0000, "estimated_amount": 4414, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5093.37, "standard_charge_percentage": 75.0000, "estimated_amount": 5093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4821.72, "standard_charge_percentage": 71.0000, "estimated_amount": 4821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1358.23, "standard_charge_percentage": 20.0000, "estimated_amount": 1358, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2383.53, "estimated_amount": 2383, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1509.5, "estimated_amount": 1509, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5432.93, "standard_charge_percentage": 80.0000, "estimated_amount": 5432, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 357.88, "estimated_amount": 357, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 2097.5, "estimated_amount": 2097, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1487.26, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1487, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 4349.08, "estimated_amount": 4349, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1867.57, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 357.88, "estimated_amount": 357, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1339.11, "estimated_amount": 1339, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4753.81, "standard_charge_percentage": 70.0000, "estimated_amount": 4753, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5432.93, "standard_charge_percentage": 80.0000, "estimated_amount": 5432, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2288.18, "estimated_amount": 2288, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5432.93, "standard_charge_percentage": 80.0000, "estimated_amount": 5432, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1868.68, "estimated_amount": 1868, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2173.17, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2173, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5432.93, "standard_charge_percentage": 80.0000, "estimated_amount": 5432, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1487.26, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1487, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2574.21, "estimated_amount": 2574, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1541.96, "estimated_amount": 1541, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1623.12, "estimated_amount": 1623, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2308.99, "standard_charge_percentage": 34.0000, "estimated_amount": 2308, "methodology": "percent of total billed charges" }]}]} , { "description": "Wound prep fnhfg", "code_information": [ { "code": "15004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4246.1, "discounted_cash": 829,"minimum": 406.72,"maximum": 4246.1,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1455.36, "estimated_amount": 1455, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1273.83, "standard_charge_percentage": 30.0000, "estimated_amount": 1273, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1033.71, "estimated_amount": 1033, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3184.57, "standard_charge_percentage": 75.0000, "estimated_amount": 3184, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 765.71, "estimated_amount": 765, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3396.88, "standard_charge_percentage": 80.0000, "estimated_amount": 3396, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 989.04, "estimated_amount": 989, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 989.04, "estimated_amount": 989, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2759.97, "standard_charge_percentage": 65.0000, "estimated_amount": 2759, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 406.72, "estimated_amount": 406, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3396.88, "standard_charge_percentage": 80.0000, "estimated_amount": 3396, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 625.33, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1108.23, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1108, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 849.22, "standard_charge_percentage": 20.0000, "estimated_amount": 849, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3014.73, "standard_charge_percentage": 71.0000, "estimated_amount": 3014, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3524.26, "standard_charge_percentage": 83.0000, "estimated_amount": 3524, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1167.68, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1167, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 929.9, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 929, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 669.99, "estimated_amount": 669, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 657.23, "estimated_amount": 657, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3396.88, "standard_charge_percentage": 80.0000, "estimated_amount": 3396, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1339.11, "estimated_amount": 1339, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 929.9, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 929, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 797.61, "estimated_amount": 797, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 733.8, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 957.13, "estimated_amount": 957, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4246.1, "estimated_amount": 4246, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2972.27, "standard_charge_percentage": 70.0000, "estimated_amount": 2972, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 701.9, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 861.42, "estimated_amount": 861, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3396.88, "standard_charge_percentage": 80.0000, "estimated_amount": 3396, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 893.33, "estimated_amount": 893, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1509.5, "estimated_amount": 1509, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 638.09, "estimated_amount": 638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1541.96, "estimated_amount": 1541, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3396.88, "standard_charge_percentage": 80.0000, "estimated_amount": 3396, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 606.19, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1358.75, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 1358, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1339.11, "estimated_amount": 1339, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 406.72, "estimated_amount": 406, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1623.12, "estimated_amount": 1623, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1443.67, "standard_charge_percentage": 34.0000, "estimated_amount": 1443, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 929.9, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 929, "methodology": "percent of total billed charges" }]}]} , { "description": "Splt agrft t/a/l 1st 100sqcm", "code_information": [ { "code": "15100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15111, "discounted_cash": 2478,"minimum": 488,"maximum": 12542.1,"payers_information":[{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 2097.5, "estimated_amount": 2097, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4155.52, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 4349.08, "estimated_amount": 4349, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 6150.74, "estimated_amount": 6150, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1811.48, "estimated_amount": 1811, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1868.68, "estimated_amount": 1868, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 12542.1, "standard_charge_percentage": 83.0000, "estimated_amount": 12542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 922.32, "estimated_amount": 922, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3022.2, "standard_charge_percentage": 20.0000, "estimated_amount": 3022, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 10577.7, "standard_charge_percentage": 70.0000, "estimated_amount": 10577, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5137.74, "standard_charge_percentage": 34.0000, "estimated_amount": 5137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3943.97, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3943, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4533.3, "standard_charge_percentage": 30.0000, "estimated_amount": 4533, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 10728.8, "standard_charge_percentage": 71.0000, "estimated_amount": 10728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6613.7, "estimated_amount": 6613, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9822.15, "standard_charge_percentage": 65.0000, "estimated_amount": 9822, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2574.21, "estimated_amount": 2574, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 922.32, "estimated_amount": 922, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2288.18, "estimated_amount": 2288, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2860.23, "estimated_amount": 2860, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 11333.3, "standard_charge_percentage": 75.0000, "estimated_amount": 11333, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 3089.05, "estimated_amount": 3089, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2669.55, "estimated_amount": 2669, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6283.01, "estimated_amount": 6283, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 2192.84, "estimated_amount": 2192, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2383.53, "estimated_amount": 2383, "methodology": "fee schedule" }]}]} , { "description": "Skn splt a-grft facnckhfg", "code_information": [ { "code": "15120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11097, "discounted_cash": 4961,"minimum": 488,"maximum": 9210.51,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 890.68, "estimated_amount": 890, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6613.7, "estimated_amount": 6613, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3329.1, "standard_charge_percentage": 30.0000, "estimated_amount": 3329, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7213.05, "standard_charge_percentage": 65.0000, "estimated_amount": 7213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5915.2, "estimated_amount": 5915, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3772.98, "standard_charge_percentage": 34.0000, "estimated_amount": 3772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2219.4, "standard_charge_percentage": 20.0000, "estimated_amount": 2219, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3625.45, "estimated_amount": 3625, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 8704.13, "estimated_amount": 8704, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5915.2, "estimated_amount": 5915, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5724.39, "estimated_amount": 5724, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 4007.07, "estimated_amount": 4007, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3930.75, "estimated_amount": 3930, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2896.32, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2896, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3739.93, "estimated_amount": 3739, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7767.9, "standard_charge_percentage": 70.0000, "estimated_amount": 7767, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 6182.34, "estimated_amount": 6182, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 9210.51, "standard_charge_percentage": 83.0000, "estimated_amount": 9210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7878.87, "standard_charge_percentage": 71.0000, "estimated_amount": 7878, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 890.68, "estimated_amount": 890, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3930.75, "estimated_amount": 3930, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 5342.76, "estimated_amount": 5342, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4579.51, "estimated_amount": 4579, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 8322.75, "standard_charge_percentage": 75.0000, "estimated_amount": 8322, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 4388.7, "estimated_amount": 4388, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 4007.07, "estimated_amount": 4007, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4770.32, "estimated_amount": 4770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 6150.74, "estimated_amount": 6150, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6283.01, "estimated_amount": 6283, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 5151.95, "estimated_amount": 5151, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 4007.07, "estimated_amount": 4007, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 4007.07, "estimated_amount": 4007, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3930.75, "estimated_amount": 3930, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3051.68, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3051, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 4197.89, "estimated_amount": 4197, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "15240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5137.25, "discounted_cash": 2478,"minimum": 558,"maximum": 4550,"payers_information":[{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1340.82, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1340, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 4263.92, "standard_charge_percentage": 83.0000, "estimated_amount": 4263, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1125.06, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1125, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3596.07, "standard_charge_percentage": 70.0000, "estimated_amount": 3596, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1868.68, "estimated_amount": 1868, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1541.17, "standard_charge_percentage": 30.0000, "estimated_amount": 1541, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2288.18, "estimated_amount": 2288, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4114.72, "estimated_amount": 4114, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3647.45, "standard_charge_percentage": 71.0000, "estimated_amount": 3647, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 3089.05, "estimated_amount": 3089, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2669.55, "estimated_amount": 2669, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 968.84, "estimated_amount": 968, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1746.66, "standard_charge_percentage": 34.0000, "estimated_amount": 1746, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4109.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4109, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 968.84, "estimated_amount": 968, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 2097.5, "estimated_amount": 2097, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4109.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4109, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4028.09, "estimated_amount": 4028, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 2192.84, "estimated_amount": 2192, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1027.45, "standard_charge_percentage": 20.0000, "estimated_amount": 1027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2383.53, "estimated_amount": 2383, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4109.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4109, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1412.74, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3339.21, "standard_charge_percentage": 65.0000, "estimated_amount": 3339, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2574.21, "estimated_amount": 2574, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4331.28, "estimated_amount": 4331, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1811.48, "estimated_amount": 1811, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3852.94, "standard_charge_percentage": 75.0000, "estimated_amount": 3852, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2860.23, "estimated_amount": 2860, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4109.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4109, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1125.06, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1125, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4109.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4109, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1125.06, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1125, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 4349.08, "estimated_amount": 4349, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" }]}]} , { "description": "Fth gr fccmnaxghf ea", "code_information": [ { "code": "15241", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7555.5,"minimum": 179.78,"maximum": 6271.06,"payers_information":[{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6044.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6044, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 179.78, "estimated_amount": 179, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6044.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6044, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1654.65, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1654, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 179.78, "estimated_amount": 179, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1654.65, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1654, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6044.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6044, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1654.65, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1654, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5288.85, "standard_charge_percentage": 70.0000, "estimated_amount": 5288, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4911.07, "standard_charge_percentage": 65.0000, "estimated_amount": 4911, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 5364.4, "standard_charge_percentage": 71.0000, "estimated_amount": 5364, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5666.63, "standard_charge_percentage": 75.0000, "estimated_amount": 5666, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1888.88, "standard_charge_percentage": 25.0000, "estimated_amount": 1888, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 6271.06, "standard_charge_percentage": 83.0000, "estimated_amount": 6271, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4019.53, "standard_charge_percentage": 53.2000, "estimated_amount": 4019, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3818.55, "standard_charge_percentage": 53.2000, "estimated_amount": 3818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 3738.16, "standard_charge_percentage": 53.2000, "estimated_amount": 3738, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2266.65, "standard_charge_percentage": 30.0000, "estimated_amount": 2266, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1971.99, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1971, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6044.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6044, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1511.1, "standard_charge_percentage": 20.0000, "estimated_amount": 1511, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6044.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6044, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2568.87, "standard_charge_percentage": 34.0000, "estimated_amount": 2568, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2077.76, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2077, "methodology": "percent of total billed charges" }]}]} , { "description": "Fth grf fr neel 20 sqcm<", "code_information": [ { "code": "15260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5856.44, "discounted_cash": 2478,"minimum": 488,"maximum": 4860.85,"payers_information":[{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4114.72, "estimated_amount": 4114, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1868.68, "estimated_amount": 1868, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2669.55, "estimated_amount": 2669, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4685.15, "standard_charge_percentage": 80.0000, "estimated_amount": 4685, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3806.69, "standard_charge_percentage": 65.0000, "estimated_amount": 3806, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2860.23, "estimated_amount": 2860, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1528.53, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1528, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4685.15, "standard_charge_percentage": 80.0000, "estimated_amount": 4685, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1171.29, "standard_charge_percentage": 20.0000, "estimated_amount": 1171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 4860.85, "standard_charge_percentage": 83.0000, "estimated_amount": 4860, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4099.51, "standard_charge_percentage": 70.0000, "estimated_amount": 4099, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 3089.05, "estimated_amount": 3089, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1811.48, "estimated_amount": 1811, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 4349.08, "estimated_amount": 4349, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1038.72, "estimated_amount": 1038, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1991.19, "standard_charge_percentage": 34.0000, "estimated_amount": 1991, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1282.56, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1282, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1610.52, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1610, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4028.09, "estimated_amount": 4028, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4685.15, "standard_charge_percentage": 80.0000, "estimated_amount": 4685, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1282.56, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1282, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1038.72, "estimated_amount": 1038, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4685.15, "standard_charge_percentage": 80.0000, "estimated_amount": 4685, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4331.28, "estimated_amount": 4331, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1282.56, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1282, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2288.18, "estimated_amount": 2288, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4685.15, "standard_charge_percentage": 80.0000, "estimated_amount": 4685, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4392.33, "standard_charge_percentage": 75.0000, "estimated_amount": 4392, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 2192.84, "estimated_amount": 2192, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4158.07, "standard_charge_percentage": 71.0000, "estimated_amount": 4158, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1756.93, "standard_charge_percentage": 30.0000, "estimated_amount": 1756, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2574.21, "estimated_amount": 2574, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 2097.5, "estimated_amount": 2097, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2383.53, "estimated_amount": 2383, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" }]}]} , { "description": "Skin sub graft trnkarmleg", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4840.33, "discounted_cash": 2478,"minimum": 157.87,"maximum": 4550,"payers_information":[{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 2446.3, "standard_charge_percentage": 53.2000, "estimated_amount": 2446, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 157.87, "estimated_amount": 157, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 3089.05, "estimated_amount": 3089, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2383.53, "estimated_amount": 2383, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3630.25, "standard_charge_percentage": 75.0000, "estimated_amount": 3630, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 4017.47, "standard_charge_percentage": 83.0000, "estimated_amount": 4017, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2575.06, "standard_charge_percentage": 53.2000, "estimated_amount": 2575, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3388.23, "standard_charge_percentage": 70.0000, "estimated_amount": 3388, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1060.03, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1060, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 4349.08, "estimated_amount": 4349, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3146.21, "standard_charge_percentage": 65.0000, "estimated_amount": 3146, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2669.55, "estimated_amount": 2669, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1060.03, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1060, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3872.26, "standard_charge_percentage": 80.0000, "estimated_amount": 3872, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 157.87, "estimated_amount": 157, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2860.23, "estimated_amount": 2860, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1263.33, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1263, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3872.26, "standard_charge_percentage": 80.0000, "estimated_amount": 3872, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 2192.84, "estimated_amount": 2192, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3872.26, "standard_charge_percentage": 80.0000, "estimated_amount": 3872, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2574.21, "estimated_amount": 2574, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2288.18, "estimated_amount": 2288, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1645.71, "standard_charge_percentage": 34.0000, "estimated_amount": 1645, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1868.68, "estimated_amount": 1868, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1811.48, "estimated_amount": 1811, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3436.63, "standard_charge_percentage": 71.0000, "estimated_amount": 3436, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1548.91, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 1548, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 2394.8, "standard_charge_percentage": 53.2000, "estimated_amount": 2394, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3872.26, "standard_charge_percentage": 80.0000, "estimated_amount": 3872, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 968.07, "standard_charge_percentage": 20.0000, "estimated_amount": 968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1452.1, "standard_charge_percentage": 30.0000, "estimated_amount": 1452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 2097.5, "estimated_amount": 2097, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1331.09, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1331, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3872.26, "standard_charge_percentage": 80.0000, "estimated_amount": 3872, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1060.03, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1060, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" }]}]} , { "description": "Skin sub graft face/nk/hf/g", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9041, "discounted_cash": 2478,"minimum": 162.36,"maximum": 7504.03,"payers_information":[{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6328.7, "standard_charge_percentage": 70.0000, "estimated_amount": 6328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1979.98, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1868.68, "estimated_amount": 1868, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1811.48, "estimated_amount": 1811, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2669.55, "estimated_amount": 2669, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 4349.08, "estimated_amount": 4349, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2860.23, "estimated_amount": 2860, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2383.53, "estimated_amount": 2383, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 162.36, "estimated_amount": 162, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7232.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7232, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2955.57, "estimated_amount": 2955, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1979.98, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 7232.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7232, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 7232.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7232, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3073.94, "standard_charge_percentage": 34.0000, "estimated_amount": 3073, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2288.18, "estimated_amount": 2288, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 162.36, "estimated_amount": 162, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4809.81, "standard_charge_percentage": 53.2000, "estimated_amount": 4809, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2893.12, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2893, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 2002.16, "estimated_amount": 2002, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2486.28, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2486, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5876.65, "standard_charge_percentage": 65.0000, "estimated_amount": 5876, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1979.98, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1979, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 2097.5, "estimated_amount": 2097, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6780.75, "standard_charge_percentage": 75.0000, "estimated_amount": 6780, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1808.2, "standard_charge_percentage": 20.0000, "estimated_amount": 1808, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1964.02, "estimated_amount": 1964, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 3089.05, "estimated_amount": 3089, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7232.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7232, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2574.21, "estimated_amount": 2574, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6419.11, "standard_charge_percentage": 71.0000, "estimated_amount": 6419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 2192.84, "estimated_amount": 2192, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7504.03, "standard_charge_percentage": 83.0000, "estimated_amount": 7504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 7232.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7232, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4473.13, "standard_charge_percentage": 53.2000, "estimated_amount": 4473, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1906.82, "estimated_amount": 1906, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4569.32, "standard_charge_percentage": 53.2000, "estimated_amount": 4569, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2359.7, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2712.3, "standard_charge_percentage": 30.0000, "estimated_amount": 2712, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" }]}]} , { "description": "Mdfc flap wprsrv vasc pedcl", "code_information": [ { "code": "15730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6613.68, "discounted_cash": 4961,"minimum": 1322.74,"maximum": 6613.68,"payers_information":[{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 4007.07, "estimated_amount": 4007, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6613.68, "estimated_amount": 6613, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5290.94, "standard_charge_percentage": 80.0000, "estimated_amount": 5290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 5151.95, "estimated_amount": 5151, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4629.58, "standard_charge_percentage": 70.0000, "estimated_amount": 4629, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 6182.34, "estimated_amount": 6182, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 5342.76, "estimated_amount": 5342, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3342.55, "standard_charge_percentage": 53.2000, "estimated_amount": 3342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3930.75, "estimated_amount": 3930, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5290.94, "standard_charge_percentage": 80.0000, "estimated_amount": 5290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 4007.07, "estimated_amount": 4007, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3625.45, "estimated_amount": 3625, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1653.42, "standard_charge_percentage": 25.0000, "estimated_amount": 1653, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 4007.07, "estimated_amount": 4007, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4770.32, "estimated_amount": 4770, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5915.2, "estimated_amount": 5915, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 4197.89, "estimated_amount": 4197, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2248.65, "standard_charge_percentage": 34.0000, "estimated_amount": 2248, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5489.35, "standard_charge_percentage": 83.0000, "estimated_amount": 5489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1322.74, "standard_charge_percentage": 20.0000, "estimated_amount": 1322, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1448.4, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1448, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4298.89, "standard_charge_percentage": 65.0000, "estimated_amount": 4298, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1448.4, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1448, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 4388.7, "estimated_amount": 4388, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5290.94, "standard_charge_percentage": 80.0000, "estimated_amount": 5290, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1448.4, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1448, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5724.39, "estimated_amount": 5724, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3930.75, "estimated_amount": 3930, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1984.1, "standard_charge_percentage": 30.0000, "estimated_amount": 1984, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1818.76, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5290.94, "standard_charge_percentage": 80.0000, "estimated_amount": 5290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 3518.48, "standard_charge_percentage": 53.2000, "estimated_amount": 3518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3930.75, "estimated_amount": 3930, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5915.2, "estimated_amount": 5915, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1726.17, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1726, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4695.71, "standard_charge_percentage": 71.0000, "estimated_amount": 4695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 4007.07, "estimated_amount": 4007, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 3272.18, "standard_charge_percentage": 53.2000, "estimated_amount": 3272, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4960.26, "standard_charge_percentage": 75.0000, "estimated_amount": 4960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3739.93, "estimated_amount": 3739, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1432.72, "estimated_amount": 1432, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2116.38, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2116, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4579.51, "estimated_amount": 4579, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5290.94, "standard_charge_percentage": 80.0000, "estimated_amount": 5290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1432.72, "estimated_amount": 1432, "methodology": "fee schedule" }]}]} , { "description": "Musc myoqfscq flp h&n pedcl", "code_information": [ { "code": "15733", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26928, "discounted_cash": 4961,"minimum": 1101.08,"maximum": 22350.2,"payers_information":[{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 4007.07, "estimated_amount": 4007, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 14325.7, "standard_charge_percentage": 53.2000, "estimated_amount": 14325, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3739.93, "estimated_amount": 3739, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5724.39, "estimated_amount": 5724, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 4007.07, "estimated_amount": 4007, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 8704.13, "estimated_amount": 8704, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1101.08, "estimated_amount": 1101, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8078.4, "standard_charge_percentage": 30.0000, "estimated_amount": 8078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3930.75, "estimated_amount": 3930, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 5342.76, "estimated_amount": 5342, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 4007.07, "estimated_amount": 4007, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 19118.9, "standard_charge_percentage": 71.0000, "estimated_amount": 19118, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 5897.23, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 5897, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5915.2, "estimated_amount": 5915, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 21542.4, "standard_charge_percentage": 80.0000, "estimated_amount": 21542, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 20196, "standard_charge_percentage": 75.0000, "estimated_amount": 20196, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3930.75, "estimated_amount": 3930, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 13322.9, "standard_charge_percentage": 53.2000, "estimated_amount": 13322, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 21542.4, "standard_charge_percentage": 80.0000, "estimated_amount": 21542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 21542.4, "standard_charge_percentage": 80.0000, "estimated_amount": 21542, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 7405.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 7405, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 21542.4, "standard_charge_percentage": 80.0000, "estimated_amount": 21542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 5151.95, "estimated_amount": 5151, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 13609.4, "standard_charge_percentage": 53.2000, "estimated_amount": 13609, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 5897.23, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 5897, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5915.2, "estimated_amount": 5915, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 8616.96, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 8616, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1101.08, "estimated_amount": 1101, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 5897.23, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 5897, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 4197.89, "estimated_amount": 4197, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 4388.7, "estimated_amount": 4388, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 5385.6, "standard_charge_percentage": 20.0000, "estimated_amount": 5385, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3625.45, "estimated_amount": 3625, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 4007.07, "estimated_amount": 4007, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 21542.4, "standard_charge_percentage": 80.0000, "estimated_amount": 21542, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3816.26, "estimated_amount": 3816, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4770.32, "estimated_amount": 4770, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 18849.6, "standard_charge_percentage": 70.0000, "estimated_amount": 18849, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 9155.52, "standard_charge_percentage": 34.0000, "estimated_amount": 9155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 6732, "standard_charge_percentage": 25.0000, "estimated_amount": 6732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 6182.34, "estimated_amount": 6182, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 17503.2, "standard_charge_percentage": 65.0000, "estimated_amount": 17503, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 22350.2, "standard_charge_percentage": 83.0000, "estimated_amount": 22350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4579.51, "estimated_amount": 4579, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3930.75, "estimated_amount": 3930, "methodology": "fee schedule" }]}]} , { "description": "Muscle-skin graft trunk", "code_information": [ { "code": "15734", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1127, "discounted_cash": 4961,"minimum": 225.4,"maximum": 1127,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 338.1, "standard_charge_percentage": 30.0000, "estimated_amount": 338, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 294.15, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 294, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 845.25, "standard_charge_percentage": 75.0000, "estimated_amount": 845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 901.6, "standard_charge_percentage": 80.0000, "estimated_amount": 901, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 800.17, "standard_charge_percentage": 71.0000, "estimated_amount": 800, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 309.93, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 901.6, "standard_charge_percentage": 80.0000, "estimated_amount": 901, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 901.6, "standard_charge_percentage": 80.0000, "estimated_amount": 901, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 246.81, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "case rate" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 383.18, "standard_charge_percentage": 34.0000, "estimated_amount": 383, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 246.81, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 732.55, "standard_charge_percentage": 65.0000, "estimated_amount": 732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 901.6, "standard_charge_percentage": 80.0000, "estimated_amount": 901, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 246.81, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 901.6, "standard_charge_percentage": 80.0000, "estimated_amount": 901, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 788.9, "standard_charge_percentage": 70.0000, "estimated_amount": 788, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 225.4, "standard_charge_percentage": 20.0000, "estimated_amount": 225, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 935.41, "standard_charge_percentage": 83.0000, "estimated_amount": 935, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1127, "estimated_amount": 1127, "methodology": "case rate" }]}]} , { "description": "Free fascial flap microvasc", "code_information": [ { "code": "15758", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15111,"minimum": 1433.3,"maximum": 12542.1,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4533.3, "standard_charge_percentage": 30.0000, "estimated_amount": 4533, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 12542.1, "standard_charge_percentage": 83.0000, "estimated_amount": 12542, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4155.52, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4155, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 7476.32, "standard_charge_percentage": 53.2000, "estimated_amount": 7476, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 3777.75, "standard_charge_percentage": 25.0000, "estimated_amount": 3777, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 2406.55, "estimated_amount": 2406, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3022.2, "standard_charge_percentage": 20.0000, "estimated_amount": 3022, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7637.1, "standard_charge_percentage": 53.2000, "estimated_amount": 7637, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 1433.3, "estimated_amount": 1433, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3943.97, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3943, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1433.3, "estimated_amount": 1433, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 10728.8, "standard_charge_percentage": 71.0000, "estimated_amount": 10728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 2406.55, "estimated_amount": 2406, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9822.15, "standard_charge_percentage": 65.0000, "estimated_amount": 9822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5137.74, "standard_charge_percentage": 34.0000, "estimated_amount": 5137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4835.52, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 4835, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 8039.05, "standard_charge_percentage": 53.2000, "estimated_amount": 8039, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 11333.3, "standard_charge_percentage": 75.0000, "estimated_amount": 11333, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 10577.7, "standard_charge_percentage": 70.0000, "estimated_amount": 10577, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "15777", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14269.6,"minimum": 232.76,"maximum": 11843.8,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4851.66, "standard_charge_percentage": 34.0000, "estimated_amount": 4851, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11415.7, "standard_charge_percentage": 80.0000, "estimated_amount": 11415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 11415.7, "standard_charge_percentage": 80.0000, "estimated_amount": 11415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 10131.4, "standard_charge_percentage": 71.0000, "estimated_amount": 10131, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 3567.4, "standard_charge_percentage": 25.0000, "estimated_amount": 3567, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 7591.43, "standard_charge_percentage": 53.2000, "estimated_amount": 7591, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3125.04, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3125, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 232.76, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 232.76, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7211.86, "standard_charge_percentage": 53.2000, "estimated_amount": 7211, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3724.37, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4280.88, "standard_charge_percentage": 30.0000, "estimated_amount": 4280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 11415.7, "standard_charge_percentage": 80.0000, "estimated_amount": 11415, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 10702.2, "standard_charge_percentage": 75.0000, "estimated_amount": 10702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11415.7, "standard_charge_percentage": 80.0000, "estimated_amount": 11415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 11415.7, "standard_charge_percentage": 80.0000, "estimated_amount": 11415, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 7060.03, "standard_charge_percentage": 53.2000, "estimated_amount": 7060, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3125.04, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3125, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9988.72, "standard_charge_percentage": 70.0000, "estimated_amount": 9988, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2853.92, "standard_charge_percentage": 20.0000, "estimated_amount": 2853, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3125.04, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3125, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2438.31, "estimated_amount": 2438, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2560.23, "estimated_amount": 2560, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3924.14, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3924, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4566.27, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 4566, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9275.24, "standard_charge_percentage": 65.0000, "estimated_amount": 9275, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 11843.8, "standard_charge_percentage": 83.0000, "estimated_amount": 11843, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Dress/Debride Burn <5% Total Sm", "code_information": [ { "code": "16020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 310, "discounted_cash": 269,"minimum": 62,"maximum": 310,"payers_information":[{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 248, "standard_charge_percentage": 80.0000, "estimated_amount": 248, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 67.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 67, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 310, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 217, "standard_charge_percentage": 70.0000, "estimated_amount": 217, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 232.5, "standard_charge_percentage": 75.0000, "estimated_amount": 232, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 164.92, "standard_charge_percentage": 53.2000, "estimated_amount": 164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 248, "standard_charge_percentage": 80.0000, "estimated_amount": 248, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 105.4, "standard_charge_percentage": 34.0000, "estimated_amount": 105, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 310, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 310, "estimated_amount": 310, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 248, "standard_charge_percentage": 80.0000, "estimated_amount": 248, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 62, "standard_charge_percentage": 20.0000, "estimated_amount": 62, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 227.83, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 93, "standard_charge_percentage": 30.0000, "estimated_amount": 93, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 248, "standard_charge_percentage": 80.0000, "estimated_amount": 248, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 156.67, "standard_charge_percentage": 53.2000, "estimated_amount": 156, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 258.9, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 310, "estimated_amount": 310, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 310, "estimated_amount": 310, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 201.5, "standard_charge_percentage": 65.0000, "estimated_amount": 201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 257.3, "standard_charge_percentage": 83.0000, "estimated_amount": 257, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 202.98, "estimated_amount": 202, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 85.25, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 85, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 248, "standard_charge_percentage": 80.0000, "estimated_amount": 248, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 310, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 310, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 80.91, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 80, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 220.1, "standard_charge_percentage": 71.0000, "estimated_amount": 220, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 289.97, "estimated_amount": 289, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 89.19, "estimated_amount": 89, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 248.54, "estimated_amount": 248, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 238.19, "estimated_amount": 238, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 240.32, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 196.76, "estimated_amount": 196, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 99.2, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 99, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 67.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 67, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 89.19, "estimated_amount": 89, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 228.88, "estimated_amount": 228, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 279.61, "estimated_amount": 279, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 153.38, "standard_charge_percentage": 53.2000, "estimated_amount": 153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 310, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 67.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 67, "methodology": "percent of total billed charges" }]}]} , { "description": "Destruct b9 lesion 1-14", "code_information": [ { "code": "17110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8652, "discounted_cash": 269,"minimum": 114.08,"maximum": 7181.16,"payers_information":[{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 310.68, "estimated_amount": 310, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2768.64, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2768, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4280.66, "standard_charge_percentage": 53.2000, "estimated_amount": 4280, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1894.79, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1894, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 248.54, "estimated_amount": 248, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 321.04, "estimated_amount": 321, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 279.61, "estimated_amount": 279, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 196.76, "estimated_amount": 196, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 2163, "standard_charge_percentage": 25.0000, "estimated_amount": 2163, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 238.19, "estimated_amount": 238, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7181.16, "standard_charge_percentage": 83.0000, "estimated_amount": 7181, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1894.79, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1894, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 472.4, "estimated_amount": 472, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2258.17, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2258, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 258.9, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6489, "standard_charge_percentage": 75.0000, "estimated_amount": 6489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 114.08, "estimated_amount": 114, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6056.4, "standard_charge_percentage": 70.0000, "estimated_amount": 6056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4602.86, "standard_charge_percentage": 53.2000, "estimated_amount": 4602, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1894.79, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1894, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 114.08, "estimated_amount": 114, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5623.8, "standard_charge_percentage": 65.0000, "estimated_amount": 5623, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 289.97, "estimated_amount": 289, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6142.92, "standard_charge_percentage": 71.0000, "estimated_amount": 6142, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 202.98, "estimated_amount": 202, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2595.6, "standard_charge_percentage": 30.0000, "estimated_amount": 2595, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6921.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1730.4, "standard_charge_percentage": 20.0000, "estimated_amount": 1730, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2379.3, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2379, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2941.68, "standard_charge_percentage": 34.0000, "estimated_amount": 2941, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4372.72, "standard_charge_percentage": 53.2000, "estimated_amount": 4372, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 335.53, "estimated_amount": 335, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 227.83, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "19001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3716.5,"minimum": 26.88,"maximum": 3716.5,"payers_information":[{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2973.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2973, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 813.91, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 813, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3084.7, "standard_charge_percentage": 83.0000, "estimated_amount": 3084, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2638.72, "standard_charge_percentage": 71.0000, "estimated_amount": 2638, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1022.04, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1022, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 970.01, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 970, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 2973.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2973, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 813.91, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 813, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1977.18, "standard_charge_percentage": 53.2000, "estimated_amount": 1977, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 2973.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2973, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1878.32, "standard_charge_percentage": 53.2000, "estimated_amount": 1878, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 900.41, "estimated_amount": 900, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 26.88, "estimated_amount": 26, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1189.28, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 1189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 2787.38, "standard_charge_percentage": 75.0000, "estimated_amount": 2787, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2973.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2973, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 929.13, "standard_charge_percentage": 25.0000, "estimated_amount": 929, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 2973.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2973, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2601.55, "standard_charge_percentage": 70.0000, "estimated_amount": 2601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 26.88, "estimated_amount": 26, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2415.72, "standard_charge_percentage": 65.0000, "estimated_amount": 2415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 743.3, "standard_charge_percentage": 20.0000, "estimated_amount": 743, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 900.41, "estimated_amount": 900, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 813.91, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 813, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3716.5, "estimated_amount": 3716, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1263.61, "standard_charge_percentage": 34.0000, "estimated_amount": 1263, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1114.95, "standard_charge_percentage": 30.0000, "estimated_amount": 1114, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1838.78, "standard_charge_percentage": 53.2000, "estimated_amount": 1838, "methodology": "percent of total billed charges" }]}]} , { "description": "Mastotomy expl drg absc dp", "code_information": [ { "code": "19020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11097, "discounted_cash": 2195,"minimum": 484.3,"maximum": 9210.51,"payers_information":[{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3329.1, "standard_charge_percentage": 30.0000, "estimated_amount": 3329, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7878.87, "standard_charge_percentage": 71.0000, "estimated_amount": 7878, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 484.3, "estimated_amount": 484, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 484.3, "estimated_amount": 484, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 9210.51, "standard_charge_percentage": 83.0000, "estimated_amount": 9210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3772.98, "standard_charge_percentage": 34.0000, "estimated_amount": 3772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2896.32, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2896, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 8322.75, "standard_charge_percentage": 75.0000, "estimated_amount": 8322, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7213.05, "standard_charge_percentage": 65.0000, "estimated_amount": 7213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5133.26, "estimated_amount": 5133, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5025.19, "estimated_amount": 5025, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2219.4, "standard_charge_percentage": 20.0000, "estimated_amount": 2219, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7767.9, "standard_charge_percentage": 70.0000, "estimated_amount": 7767, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 5403.43, "estimated_amount": 5403, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3051.68, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3051, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Bx Breast W Device Stereotact Guide 1St Lesion", "code_information": [ { "code": "19081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6804, "discounted_cash": 2195,"minimum": 490.72,"maximum": 5647.32,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4422.6, "standard_charge_percentage": 65.0000, "estimated_amount": 4422, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5443.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5443, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5443.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5443, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1490.08, "standard_charge_percentage": 21.9000, "estimated_amount": 1490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1490.08, "standard_charge_percentage": 21.9000, "estimated_amount": 1490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 490.72, "estimated_amount": 490, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5443.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5443, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5103, "standard_charge_percentage": 75.0000, "estimated_amount": 5103, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2041.2, "standard_charge_percentage": 30.0000, "estimated_amount": 2041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2313.36, "standard_charge_percentage": 34.0000, "estimated_amount": 2313, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1360.8, "standard_charge_percentage": 20.0000, "estimated_amount": 1360, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 3619.73, "standard_charge_percentage": 53.2000, "estimated_amount": 3619, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 3366.35, "standard_charge_percentage": 53.2000, "estimated_amount": 3366, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5647.32, "standard_charge_percentage": 83.0000, "estimated_amount": 5647, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5443.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5443, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5443.2, "standard_charge_percentage": 80.0000, "estimated_amount": 5443, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 5579.28, "standard_charge_percentage": 82.0000, "estimated_amount": 5579, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1775.84, "standard_charge_percentage": 26.1000, "estimated_amount": 1775, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1490.08, "standard_charge_percentage": 21.9000, "estimated_amount": 1490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3438.74, "standard_charge_percentage": 53.2000, "estimated_amount": 3438, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4762.8, "standard_charge_percentage": 70.0000, "estimated_amount": 4762, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 490.72, "estimated_amount": 490, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4830.84, "standard_charge_percentage": 71.0000, "estimated_amount": 4830, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1871.1, "standard_charge_percentage": 27.5000, "estimated_amount": 1871, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "19082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4608,"minimum": 370.94,"maximum": 4550,"payers_information":[{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3271.68, "standard_charge_percentage": 71.0000, "estimated_amount": 3271, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3824.64, "standard_charge_percentage": 83.0000, "estimated_amount": 3824, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3456, "standard_charge_percentage": 75.0000, "estimated_amount": 3456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3686.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3686, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 370.94, "estimated_amount": 370, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1566.72, "standard_charge_percentage": 34.0000, "estimated_amount": 1566, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1009.15, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1009.15, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3686.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3686, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 2279.85, "standard_charge_percentage": 53.2000, "estimated_amount": 2279, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3225.6, "standard_charge_percentage": 70.0000, "estimated_amount": 3225, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1267.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1267, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1009.15, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 370.94, "estimated_amount": 370, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3686.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3686, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 2328.88, "standard_charge_percentage": 53.2000, "estimated_amount": 2328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3686.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3686, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 921.6, "standard_charge_percentage": 20.0000, "estimated_amount": 921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2995.2, "standard_charge_percentage": 65.0000, "estimated_amount": 2995, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3686.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3686, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2451.46, "standard_charge_percentage": 53.2000, "estimated_amount": 2451, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1152, "standard_charge_percentage": 25.0000, "estimated_amount": 1152, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1202.69, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1202, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1382.4, "standard_charge_percentage": 30.0000, "estimated_amount": 1382, "methodology": "percent of total billed charges" }]}]} , { "description": "Bx breast 1st lesion us imag", "code_information": [ { "code": "19083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5453, "discounted_cash": 2195,"minimum": 484.55,"maximum": 4550,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1194.21, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1194, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4362.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4362, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1090.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1090, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3817.1, "standard_charge_percentage": 70.0000, "estimated_amount": 3817, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 4525.99, "standard_charge_percentage": 83.0000, "estimated_amount": 4525, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1423.23, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3544.45, "standard_charge_percentage": 65.0000, "estimated_amount": 3544, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1854.02, "standard_charge_percentage": 34.0000, "estimated_amount": 1854, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 2755.95, "standard_charge_percentage": 53.2000, "estimated_amount": 2755, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1635.9, "standard_charge_percentage": 30.0000, "estimated_amount": 1635, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4089.75, "standard_charge_percentage": 75.0000, "estimated_amount": 4089, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4362.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4362, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4362.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4362, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4362.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4362, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 484.55, "estimated_amount": 484, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1194.21, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1194, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1194.21, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1194, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2901, "standard_charge_percentage": 53.2000, "estimated_amount": 2901, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3871.63, "standard_charge_percentage": 71.0000, "estimated_amount": 3871, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1499.58, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4362.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4362, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 484.55, "estimated_amount": 484, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 2697.93, "standard_charge_percentage": 53.2000, "estimated_amount": 2697, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" }]}]} , { "description": "US TESTICLE SONO", "code_information": [ { "code": "19084", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2412,"minimum": 364.04,"maximum": 2001.96,"payers_information":[{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 2001.96, "standard_charge_percentage": 83.0000, "estimated_amount": 2001, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1929.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1929, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 663.3, "standard_charge_percentage": 27.5000, "estimated_amount": 663, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 820.08, "standard_charge_percentage": 34.0000, "estimated_amount": 820, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 629.53, "standard_charge_percentage": 26.1000, "estimated_amount": 629, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1567.8, "standard_charge_percentage": 65.0000, "estimated_amount": 1567, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1688.4, "standard_charge_percentage": 70.0000, "estimated_amount": 1688, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 603, "standard_charge_percentage": 25.0000, "estimated_amount": 603, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 528.23, "standard_charge_percentage": 21.9000, "estimated_amount": 528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 528.23, "standard_charge_percentage": 21.9000, "estimated_amount": 528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1977.84, "standard_charge_percentage": 82.0000, "estimated_amount": 1977, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 364.04, "estimated_amount": 364, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1219.02, "standard_charge_percentage": 53.2000, "estimated_amount": 1219, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1712.52, "standard_charge_percentage": 71.0000, "estimated_amount": 1712, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 528.23, "standard_charge_percentage": 21.9000, "estimated_amount": 528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 482.4, "standard_charge_percentage": 20.0000, "estimated_amount": 482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1809, "standard_charge_percentage": 75.0000, "estimated_amount": 1809, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 364.04, "estimated_amount": 364, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1193.36, "standard_charge_percentage": 53.2000, "estimated_amount": 1193, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 723.6, "standard_charge_percentage": 30.0000, "estimated_amount": 723, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1929.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1929, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1283.18, "standard_charge_percentage": 53.2000, "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1929.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1929, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1929.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1929, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1929.6, "standard_charge_percentage": 80.0000, "estimated_amount": 1929, "methodology": "percent of total billed charges" }]}]} , { "description": "Bx Breast Percut W/O Image", "code_information": [ { "code": "19100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10068, "discounted_cash": 2195,"minimum": 153.61,"maximum": 8356.44,"payers_information":[{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 8356.44, "standard_charge_percentage": 83.0000, "estimated_amount": 8356, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 153.61, "estimated_amount": 153, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2204.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2204, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1120.64, "estimated_amount": 1120, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7047.6, "standard_charge_percentage": 70.0000, "estimated_amount": 7047, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2013.6, "standard_charge_percentage": 20.0000, "estimated_amount": 2013, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2768.7, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2768, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3020.4, "standard_charge_percentage": 30.0000, "estimated_amount": 3020, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 153.61, "estimated_amount": 153, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2627.75, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2627, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 7551, "standard_charge_percentage": 75.0000, "estimated_amount": 7551, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1144.74, "estimated_amount": 1144, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2204.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3423.12, "standard_charge_percentage": 34.0000, "estimated_amount": 3423, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2204.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1442, "estimated_amount": 1442, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 6544.2, "standard_charge_percentage": 65.0000, "estimated_amount": 6544, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1204.99, "estimated_amount": 1204, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7148.28, "standard_charge_percentage": 71.0000, "estimated_amount": 7148, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" }]}]} , { "description": "Biopsy Of Breast Open", "code_information": [ { "code": "19101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17118, "discounted_cash": 5189,"minimum": 341.41,"maximum": 14207.9,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 4111.46, "estimated_amount": 4111, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 6466.57, "estimated_amount": 6466, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 12838.5, "standard_charge_percentage": 75.0000, "estimated_amount": 12838, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 14207.9, "standard_charge_percentage": 83.0000, "estimated_amount": 14207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4790.05, "estimated_amount": 4790, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5987.56, "estimated_amount": 5987, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5652.26, "estimated_amount": 5652, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 5588.39, "estimated_amount": 5588, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4989.64, "estimated_amount": 4989, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 4111.46, "estimated_amount": 4111, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 4111.46, "estimated_amount": 4111, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4707.45, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4707, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5820.12, "standard_charge_percentage": 34.0000, "estimated_amount": 5820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 12153.8, "standard_charge_percentage": 71.0000, "estimated_amount": 12153, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3792.12, "estimated_amount": 3792, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3423.6, "standard_charge_percentage": 20.0000, "estimated_amount": 3423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 6187.15, "estimated_amount": 6187, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 341.41, "estimated_amount": 341, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 4590.47, "estimated_amount": 4590, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3748.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3748, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 9104.29, "estimated_amount": 9104, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 5949.75, "estimated_amount": 5949, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5533.27, "estimated_amount": 5533, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 11126.7, "standard_charge_percentage": 65.0000, "estimated_amount": 11126, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3748.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3748, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 5388.81, "estimated_amount": 5388, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3911.88, "estimated_amount": 3911, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5135.4, "standard_charge_percentage": 30.0000, "estimated_amount": 5135, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 6187.15, "estimated_amount": 6187, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3748.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3748, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 4390.88, "estimated_amount": 4390, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 341.41, "estimated_amount": 341, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 11982.6, "standard_charge_percentage": 70.0000, "estimated_amount": 11982, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4467.8, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4467, "methodology": "percent of total billed charges" }]}]} , { "description": "Removal of breast lesion", "code_information": [ { "code": "19120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12635, "discounted_cash": 5189,"minimum": 558,"maximum": 10487,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2767.07, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 6187.15, "estimated_amount": 6187, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3297.74, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3297, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10108, "standard_charge_percentage": 80.0000, "estimated_amount": 10108, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10108, "standard_charge_percentage": 80.0000, "estimated_amount": 10108, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 5588.39, "estimated_amount": 5588, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 4390.88, "estimated_amount": 4390, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2527, "standard_charge_percentage": 20.0000, "estimated_amount": 2527, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 8970.85, "standard_charge_percentage": 71.0000, "estimated_amount": 8970, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 4590.47, "estimated_amount": 4590, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8212.75, "standard_charge_percentage": 65.0000, "estimated_amount": 8212, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3474.63, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3474, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3792.12, "estimated_amount": 3792, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 4111.46, "estimated_amount": 4111, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4989.64, "estimated_amount": 4989, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 6187.15, "estimated_amount": 6187, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 5949.75, "estimated_amount": 5949, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4790.05, "estimated_amount": 4790, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 5388.81, "estimated_amount": 5388, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 6466.57, "estimated_amount": 6466, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10108, "standard_charge_percentage": 80.0000, "estimated_amount": 10108, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3790.5, "standard_charge_percentage": 30.0000, "estimated_amount": 3790, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2767.07, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2767, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10108, "standard_charge_percentage": 80.0000, "estimated_amount": 10108, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 4111.46, "estimated_amount": 4111, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9476.25, "standard_charge_percentage": 75.0000, "estimated_amount": 9476, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3911.88, "estimated_amount": 3911, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5652.26, "estimated_amount": 5652, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 4111.46, "estimated_amount": 4111, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 9104.29, "estimated_amount": 9104, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5533.27, "estimated_amount": 5533, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10487, "standard_charge_percentage": 83.0000, "estimated_amount": 10487, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 566.09, "estimated_amount": 566, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5987.56, "estimated_amount": 5987, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2767.07, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2767, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 8844.5, "standard_charge_percentage": 70.0000, "estimated_amount": 8844, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 566.09, "estimated_amount": 566, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4295.9, "standard_charge_percentage": 34.0000, "estimated_amount": 4295, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10108, "standard_charge_percentage": 80.0000, "estimated_amount": 10108, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" }]}]} , { "description": "Excision breast lesion", "code_information": [ { "code": "19125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13148, "discounted_cash": 5189,"minimum": 558,"maximum": 10912.8,"payers_information":[{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4989.64, "estimated_amount": 4989, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9335.08, "standard_charge_percentage": 71.0000, "estimated_amount": 9335, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 5588.39, "estimated_amount": 5588, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9861, "standard_charge_percentage": 75.0000, "estimated_amount": 9861, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2629.6, "standard_charge_percentage": 20.0000, "estimated_amount": 2629, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3792.12, "estimated_amount": 3792, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4790.05, "estimated_amount": 4790, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3944.4, "standard_charge_percentage": 30.0000, "estimated_amount": 3944, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 9104.29, "estimated_amount": 9104, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 4111.46, "estimated_amount": 4111, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2879.41, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 6187.15, "estimated_amount": 6187, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 626.7, "estimated_amount": 626, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9203.6, "standard_charge_percentage": 70.0000, "estimated_amount": 9203, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4470.32, "standard_charge_percentage": 34.0000, "estimated_amount": 4470, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 5388.81, "estimated_amount": 5388, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3615.7, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3615, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5533.27, "estimated_amount": 5533, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10912.8, "standard_charge_percentage": 83.0000, "estimated_amount": 10912, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 4390.88, "estimated_amount": 4390, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 6187.15, "estimated_amount": 6187, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 4111.46, "estimated_amount": 4111, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3431.63, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3431, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 4590.47, "estimated_amount": 4590, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2879.41, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2879, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2879.41, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 6466.57, "estimated_amount": 6466, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3911.88, "estimated_amount": 3911, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 4111.46, "estimated_amount": 4111, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5987.56, "estimated_amount": 5987, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5652.26, "estimated_amount": 5652, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 5949.75, "estimated_amount": 5949, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8546.2, "standard_charge_percentage": 65.0000, "estimated_amount": 8546, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 626.7, "estimated_amount": 626, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" }]}]} , { "description": "Perq device breast 1st imag", "code_information": [ { "code": "19281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3769, "discounted_cash": 2195,"minimum": 232,"maximum": 3769,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1281.46, "standard_charge_percentage": 34.0000, "estimated_amount": 1281, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2638.3, "standard_charge_percentage": 70.0000, "estimated_amount": 2638, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 232, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 2826.75, "standard_charge_percentage": 75.0000, "estimated_amount": 2826, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2675.99, "standard_charge_percentage": 71.0000, "estimated_amount": 2675, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 241.69, "estimated_amount": 241, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3015.2, "standard_charge_percentage": 80.0000, "estimated_amount": 3015, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 983.71, "standard_charge_percentage": 26.1000, "estimated_amount": 983, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2005.11, "standard_charge_percentage": 53.2000, "estimated_amount": 2005, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 753.8, "standard_charge_percentage": 20.0000, "estimated_amount": 753, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3015.2, "standard_charge_percentage": 80.0000, "estimated_amount": 3015, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3015.2, "standard_charge_percentage": 80.0000, "estimated_amount": 3015, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1036.47, "standard_charge_percentage": 27.5000, "estimated_amount": 1036, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3090.58, "standard_charge_percentage": 82.0000, "estimated_amount": 3090, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2449.85, "standard_charge_percentage": 65.0000, "estimated_amount": 2449, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3015.2, "standard_charge_percentage": 80.0000, "estimated_amount": 3015, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 825.41, "standard_charge_percentage": 21.9000, "estimated_amount": 825, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 825.41, "standard_charge_percentage": 21.9000, "estimated_amount": 825, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3128.27, "standard_charge_percentage": 83.0000, "estimated_amount": 3128, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1864.75, "standard_charge_percentage": 53.2000, "estimated_amount": 1864, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1130.7, "standard_charge_percentage": 30.0000, "estimated_amount": 1130, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 825.41, "standard_charge_percentage": 21.9000, "estimated_amount": 825, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1904.85, "standard_charge_percentage": 53.2000, "estimated_amount": 1904, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3015.2, "standard_charge_percentage": 80.0000, "estimated_amount": 3015, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3769, "estimated_amount": 3769, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 241.69, "estimated_amount": 241, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" }]}]} , { "description": "Perq dev breast 1st strtctc", "code_information": [ { "code": "19283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4265, "discounted_cash": 953,"minimum": 232,"maximum": 3539.95,"payers_information":[{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1172.88, "standard_charge_percentage": 27.5000, "estimated_amount": 1172, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1113.16, "standard_charge_percentage": 26.1000, "estimated_amount": 1113, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1188.16, "estimated_amount": 1188, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3198.75, "standard_charge_percentage": 75.0000, "estimated_amount": 3198, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 934.03, "standard_charge_percentage": 21.9000, "estimated_amount": 934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 934.03, "standard_charge_percentage": 21.9000, "estimated_amount": 934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 934.03, "standard_charge_percentage": 21.9000, "estimated_amount": 934, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2985.5, "standard_charge_percentage": 70.0000, "estimated_amount": 2985, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3412, "standard_charge_percentage": 80.0000, "estimated_amount": 3412, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3028.15, "standard_charge_percentage": 71.0000, "estimated_amount": 3028, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1279.5, "standard_charge_percentage": 30.0000, "estimated_amount": 1279, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3412, "standard_charge_percentage": 80.0000, "estimated_amount": 3412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 2155.53, "standard_charge_percentage": 53.2000, "estimated_amount": 2155, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 2110.15, "standard_charge_percentage": 53.2000, "estimated_amount": 2110, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1672.81, "estimated_amount": 1672, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 258.21, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 232, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3412, "standard_charge_percentage": 80.0000, "estimated_amount": 3412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3412, "standard_charge_percentage": 80.0000, "estimated_amount": 3412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1450.1, "standard_charge_percentage": 34.0000, "estimated_amount": 1450, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3412, "standard_charge_percentage": 80.0000, "estimated_amount": 3412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2772.25, "standard_charge_percentage": 65.0000, "estimated_amount": 2772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 258.21, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3497.3, "standard_charge_percentage": 82.0000, "estimated_amount": 3497, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 853, "standard_charge_percentage": 20.0000, "estimated_amount": 853, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3539.95, "standard_charge_percentage": 83.0000, "estimated_amount": 3539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2268.98, "standard_charge_percentage": 53.2000, "estimated_amount": 2268, "methodology": "percent of total billed charges" }]}]} , { "description": "Perq dev breast 1st us imag", "code_information": [ { "code": "19285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4208, "discounted_cash": 953,"minimum": 355.03,"maximum": 3492.64,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 921.55, "standard_charge_percentage": 21.9000, "estimated_amount": 921, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3156, "standard_charge_percentage": 75.0000, "estimated_amount": 3156, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 355.03, "estimated_amount": 355, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3450.56, "standard_charge_percentage": 82.0000, "estimated_amount": 3450, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 2126.72, "standard_charge_percentage": 53.2000, "estimated_amount": 2126, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2987.68, "standard_charge_percentage": 71.0000, "estimated_amount": 2987, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3492.64, "standard_charge_percentage": 83.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2945.6, "standard_charge_percentage": 70.0000, "estimated_amount": 2945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 841.6, "standard_charge_percentage": 20.0000, "estimated_amount": 841, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1430.72, "standard_charge_percentage": 34.0000, "estimated_amount": 1430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3366.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3366, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1672.81, "estimated_amount": 1672, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1767.36, "standard_charge_percentage": 42.0000, "estimated_amount": 1767, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1098.29, "standard_charge_percentage": 26.1000, "estimated_amount": 1098, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3366.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3366, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1157.2, "standard_charge_percentage": 27.5000, "estimated_amount": 1157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 921.55, "standard_charge_percentage": 21.9000, "estimated_amount": 921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1188.16, "estimated_amount": 1188, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3366.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3366, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 2081.95, "standard_charge_percentage": 53.2000, "estimated_amount": 2081, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1670.6, "estimated_amount": 1670, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3366.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3366, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1754.13, "estimated_amount": 1754, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3366.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3366, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 921.55, "standard_charge_percentage": 21.9000, "estimated_amount": 921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1262.4, "standard_charge_percentage": 30.0000, "estimated_amount": 1262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2238.66, "standard_charge_percentage": 53.2000, "estimated_amount": 2238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2735.2, "standard_charge_percentage": 65.0000, "estimated_amount": 2735, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 355.03, "estimated_amount": 355, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" }]}]} , { "description": "US XTR NON VASC LMTD", "code_information": [ { "code": "19286", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1001,"minimum": 200.2,"maximum": 1001,"payers_information":[{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 250.25, "standard_charge_percentage": 25.0000, "estimated_amount": 250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 286.71, "estimated_amount": 286, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 219.22, "standard_charge_percentage": 21.9000, "estimated_amount": 219, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 800.8, "standard_charge_percentage": 80.0000, "estimated_amount": 800, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1001, "estimated_amount": 1001, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1001, "estimated_amount": 1001, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 200.2, "standard_charge_percentage": 20.0000, "estimated_amount": 200, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1001, "estimated_amount": 1001, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 505.91, "standard_charge_percentage": 53.2000, "estimated_amount": 505, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 800.8, "standard_charge_percentage": 80.0000, "estimated_amount": 800, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 219.22, "standard_charge_percentage": 21.9000, "estimated_amount": 219, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 800.8, "standard_charge_percentage": 80.0000, "estimated_amount": 800, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1001, "estimated_amount": 1001, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 300.3, "standard_charge_percentage": 30.0000, "estimated_amount": 300, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 750.75, "standard_charge_percentage": 75.0000, "estimated_amount": 750, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 261.26, "standard_charge_percentage": 26.1000, "estimated_amount": 261, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 800.8, "standard_charge_percentage": 80.0000, "estimated_amount": 800, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 340.34, "standard_charge_percentage": 34.0000, "estimated_amount": 340, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 532.53, "standard_charge_percentage": 53.2000, "estimated_amount": 532, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1001, "estimated_amount": 1001, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 820.82, "standard_charge_percentage": 82.0000, "estimated_amount": 820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1001, "estimated_amount": 1001, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 495.25, "standard_charge_percentage": 53.2000, "estimated_amount": 495, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1001, "estimated_amount": 1001, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 700.7, "standard_charge_percentage": 70.0000, "estimated_amount": 700, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 420.42, "standard_charge_percentage": 42.0000, "estimated_amount": 420, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 275.27, "standard_charge_percentage": 27.5000, "estimated_amount": 275, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 286.71, "estimated_amount": 286, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 650.65, "standard_charge_percentage": 65.0000, "estimated_amount": 650, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 830.83, "standard_charge_percentage": 83.0000, "estimated_amount": 830, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 800.8, "standard_charge_percentage": 80.0000, "estimated_amount": 800, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1001, "estimated_amount": 1001, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1001, "estimated_amount": 1001, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 710.71, "standard_charge_percentage": 71.0000, "estimated_amount": 710, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 219.22, "standard_charge_percentage": 21.9000, "estimated_amount": 219, "methodology": "percent of total billed charges" }]}]} , { "description": "Partial mastectomy", "code_information": [ { "code": "19301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13312, "discounted_cash": 5189,"minimum": 558,"maximum": 11049,"payers_information":[{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10649.6, "standard_charge_percentage": 80.0000, "estimated_amount": 10649, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4289.37, "estimated_amount": 4289, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 4111.46, "estimated_amount": 4111, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9984, "standard_charge_percentage": 75.0000, "estimated_amount": 9984, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10649.6, "standard_charge_percentage": 80.0000, "estimated_amount": 10649, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8652.8, "standard_charge_percentage": 65.0000, "estimated_amount": 8652, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3474.43, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3474, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2915.33, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2915, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 6187.15, "estimated_amount": 6187, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5533.27, "estimated_amount": 5533, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5987.56, "estimated_amount": 5987, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 6466.57, "estimated_amount": 6466, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10649.6, "standard_charge_percentage": 80.0000, "estimated_amount": 10649, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3911.88, "estimated_amount": 3911, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 5588.39, "estimated_amount": 5588, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4526.08, "standard_charge_percentage": 34.0000, "estimated_amount": 4526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9451.52, "standard_charge_percentage": 71.0000, "estimated_amount": 9451, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 737.68, "estimated_amount": 737, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4790.05, "estimated_amount": 4790, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 4590.47, "estimated_amount": 4590, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4259.84, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 4259, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3792.12, "estimated_amount": 3792, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 4111.46, "estimated_amount": 4111, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 737.68, "estimated_amount": 737, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3993.6, "standard_charge_percentage": 30.0000, "estimated_amount": 3993, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10649.6, "standard_charge_percentage": 80.0000, "estimated_amount": 10649, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5652.26, "estimated_amount": 5652, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4989.64, "estimated_amount": 4989, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 5388.81, "estimated_amount": 5388, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3660.8, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3660, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2915.33, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2915, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 5949.75, "estimated_amount": 5949, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4289.37, "estimated_amount": 4289, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2915.33, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2915, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 9104.29, "estimated_amount": 9104, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 4390.88, "estimated_amount": 4390, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 4111.46, "estimated_amount": 4111, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9318.4, "standard_charge_percentage": 70.0000, "estimated_amount": 9318, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 6187.15, "estimated_amount": 6187, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2662.4, "standard_charge_percentage": 20.0000, "estimated_amount": 2662, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10649.6, "standard_charge_percentage": 80.0000, "estimated_amount": 10649, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 11049, "standard_charge_percentage": 83.0000, "estimated_amount": 11048, "methodology": "percent of total billed charges" }]}]} , { "description": "P-mastectomy wln removal", "code_information": [ { "code": "19302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32050, "discounted_cash": 8837,"minimum": 1015.06,"maximum": 26601.5,"payers_information":[{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7002.04, "estimated_amount": 7002, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 25640, "standard_charge_percentage": 80.0000, "estimated_amount": 25640, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 25640, "standard_charge_percentage": 80.0000, "estimated_amount": 25640, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 26601.5, "standard_charge_percentage": 83.0000, "estimated_amount": 26601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 9528, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 9528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9615, "standard_charge_percentage": 30.0000, "estimated_amount": 9615, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 10897, "standard_charge_percentage": 34.0000, "estimated_amount": 10897, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 25640, "standard_charge_percentage": 80.0000, "estimated_amount": 25640, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4289.37, "estimated_amount": 4289, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 20832.5, "standard_charge_percentage": 65.0000, "estimated_amount": 20832, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8157.72, "estimated_amount": 8157, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 6458.19, "estimated_amount": 6458, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1015.06, "estimated_amount": 1015, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 25640, "standard_charge_percentage": 80.0000, "estimated_amount": 25640, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4289.37, "estimated_amount": 4289, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 9517.34, "estimated_amount": 9517, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3647, "estimated_amount": 3647, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 10619.2, "estimated_amount": 10619, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7002.04, "estimated_amount": 7002, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 11418.4, "estimated_amount": 11418, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8813.75, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8813, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 8497.63, "estimated_amount": 8497, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 22435, "standard_charge_percentage": 70.0000, "estimated_amount": 22435, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7138.01, "estimated_amount": 7138, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 10197.2, "estimated_amount": 10197, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1090, "estimated_amount": 1090, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 22755.5, "standard_charge_percentage": 71.0000, "estimated_amount": 22755, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7138.01, "estimated_amount": 7138, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 10537.1, "estimated_amount": 10537, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 10537.1, "estimated_amount": 10537, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 24037.5, "standard_charge_percentage": 75.0000, "estimated_amount": 24037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 7817.81, "estimated_amount": 7817, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 6410, "standard_charge_percentage": 20.0000, "estimated_amount": 6410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 6662.14, "estimated_amount": 6662, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 10847.5, "estimated_amount": 10847, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 15505.1, "estimated_amount": 15505, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7138.01, "estimated_amount": 7138, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7002.04, "estimated_amount": 7002, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 25640, "standard_charge_percentage": 80.0000, "estimated_amount": 25640, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 9177.43, "estimated_amount": 9177, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7138.01, "estimated_amount": 7138, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 11012.9, "estimated_amount": 11012, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 7477.91, "estimated_amount": 7477, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1015.06, "estimated_amount": 1015, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" }]}]} , { "description": "Mast simple complete", "code_information": [ { "code": "19303", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45402, "discounted_cash": 8837,"minimum": 690,"maximum": 37683.7,"payers_information":[{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 13620.6, "standard_charge_percentage": 30.0000, "estimated_amount": 13620, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 36321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 36321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8214.07, "estimated_amount": 8214, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 10537.1, "estimated_amount": 10537, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 7477.91, "estimated_amount": 7477, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 37683.7, "standard_charge_percentage": 83.0000, "estimated_amount": 37683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7002.04, "estimated_amount": 7002, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 15436.7, "standard_charge_percentage": 34.0000, "estimated_amount": 15436, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7002.04, "estimated_amount": 7002, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7138.01, "estimated_amount": 7138, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 10197.2, "estimated_amount": 10197, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1074.55, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 36321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 36321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7138.01, "estimated_amount": 7138, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 29511.3, "standard_charge_percentage": 65.0000, "estimated_amount": 29511, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 9528, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 9528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 11012.9, "estimated_amount": 11012, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7138.01, "estimated_amount": 7138, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 34051.5, "standard_charge_percentage": 75.0000, "estimated_amount": 34051, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 9177.43, "estimated_amount": 9177, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7138.01, "estimated_amount": 7138, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 6458.19, "estimated_amount": 6458, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 9517.34, "estimated_amount": 9517, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4289.37, "estimated_amount": 4289, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 8497.63, "estimated_amount": 8497, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 8041.14, "estimated_amount": 8041, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1074.55, "estimated_amount": 1074, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 6662.14, "estimated_amount": 6662, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4289.37, "estimated_amount": 4289, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 15505.1, "estimated_amount": 15505, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 36321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 36321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 32235.4, "standard_charge_percentage": 71.0000, "estimated_amount": 32235, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8157.72, "estimated_amount": 8157, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8889, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 36321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 36321, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 36321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 36321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 7817.81, "estimated_amount": 7817, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 8646.39, "estimated_amount": 8646, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 9080.4, "standard_charge_percentage": 20.0000, "estimated_amount": 9080, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 31781.4, "standard_charge_percentage": 70.0000, "estimated_amount": 31781, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7002.04, "estimated_amount": 7002, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 10537.1, "estimated_amount": 10537, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "19342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5034, "discounted_cash": 12967,"minimum": 558,"maximum": 5034,"payers_information":[{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1384.35, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3272.1, "standard_charge_percentage": 65.0000, "estimated_amount": 3272, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1102.45, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3574.14, "standard_charge_percentage": 71.0000, "estimated_amount": 3574, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1006.8, "standard_charge_percentage": 20.0000, "estimated_amount": 1006, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3523.8, "standard_charge_percentage": 70.0000, "estimated_amount": 3523, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4289.37, "estimated_amount": 4289, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1102.45, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4027.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4027, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4027.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4027, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1102.45, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1102, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 822.42, "estimated_amount": 822, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1711.56, "standard_charge_percentage": 34.0000, "estimated_amount": 1711, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 4178.22, "standard_charge_percentage": 83.0000, "estimated_amount": 4178, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1313.87, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1313, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4027.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4027.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1510.2, "standard_charge_percentage": 30.0000, "estimated_amount": 1510, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 822.42, "estimated_amount": 822, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3775.5, "standard_charge_percentage": 75.0000, "estimated_amount": 3775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4027.2, "standard_charge_percentage": 80.0000, "estimated_amount": 4027, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4289.37, "estimated_amount": 4289, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 5034, "estimated_amount": 5034, "methodology": "fee schedule" }]}]} , { "description": "Tiss xpndr plmt brst rcnstj", "code_information": [ { "code": "19357", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11963.2, "discounted_cash": 23577,"minimum": 785,"maximum": 11963.2,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 8972.4, "standard_charge_percentage": 75.0000, "estimated_amount": 8972, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 9070.4, "estimated_amount": 9070, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9570.56, "standard_charge_percentage": 80.0000, "estimated_amount": 9570, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9570.56, "standard_charge_percentage": 80.0000, "estimated_amount": 9570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2619.94, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2619, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 8493.87, "standard_charge_percentage": 71.0000, "estimated_amount": 8493, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7776.08, "standard_charge_percentage": 65.0000, "estimated_amount": 7776, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 9523.92, "estimated_amount": 9523, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9070.4, "estimated_amount": 9070, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 785, "estimated_amount": 785, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2392.64, "standard_charge_percentage": 20.0000, "estimated_amount": 2392, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4067.49, "standard_charge_percentage": 34.0000, "estimated_amount": 4067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3588.96, "standard_charge_percentage": 30.0000, "estimated_amount": 3588, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 9523.92, "estimated_amount": 9523, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 9070.4, "estimated_amount": 9070, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 9070.4, "estimated_amount": 9070, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 9929.46, "standard_charge_percentage": 83.0000, "estimated_amount": 9929, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 9570.56, "standard_charge_percentage": 80.0000, "estimated_amount": 9570, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3289.88, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 9070.4, "estimated_amount": 9070, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2619.94, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2619, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2619.94, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2619, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 9570.56, "standard_charge_percentage": 80.0000, "estimated_amount": 9570, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 5150, "estimated_amount": 5150, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 9070.4, "estimated_amount": 9070, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 9570.56, "standard_charge_percentage": 80.0000, "estimated_amount": 9570, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 8374.24, "standard_charge_percentage": 70.0000, "estimated_amount": 8374, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3122.4, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3122, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1247.6, "estimated_amount": 1247, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1247.6, "estimated_amount": 1247, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 11963.2, "estimated_amount": 11963, "methodology": "fee schedule" }]}]} , { "description": "Revj peri-implt capsule brst", "code_information": [ { "code": "19370", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4592.25, "discounted_cash": 5189,"minimum": 690,"maximum": 4592.25,"payers_information":[{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4592.25, "estimated_amount": 4592, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3673.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3673, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1005.7, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1005, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2984.96, "standard_charge_percentage": 65.0000, "estimated_amount": 2984, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 726.67, "estimated_amount": 726, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1561.37, "standard_charge_percentage": 34.0000, "estimated_amount": 1561, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3673.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3673, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4592.25, "estimated_amount": 4592, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 4590.47, "estimated_amount": 4590, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3792.12, "estimated_amount": 3792, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 726.67, "estimated_amount": 726, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1005.7, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1005, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3673.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3673.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3444.19, "standard_charge_percentage": 75.0000, "estimated_amount": 3444, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3214.57, "standard_charge_percentage": 70.0000, "estimated_amount": 3214, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 4111.46, "estimated_amount": 4111, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1377.67, "standard_charge_percentage": 30.0000, "estimated_amount": 1377, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1005.7, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1005, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4592.25, "estimated_amount": 4592, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4592.25, "estimated_amount": 4592, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4289.37, "estimated_amount": 4289, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 4592.25, "estimated_amount": 4592, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4592.25, "estimated_amount": 4592, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 918.45, "standard_charge_percentage": 20.0000, "estimated_amount": 918, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1198.58, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1198, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4592.25, "estimated_amount": 4592, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4289.37, "estimated_amount": 4289, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 4111.46, "estimated_amount": 4111, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4592.25, "estimated_amount": 4592, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3811.57, "standard_charge_percentage": 83.0000, "estimated_amount": 3811, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4592.25, "estimated_amount": 4592, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3911.88, "estimated_amount": 3911, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3673.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4592.25, "estimated_amount": 4592, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 4191.3, "estimated_amount": 4191, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 4111.46, "estimated_amount": 4111, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3260.5, "standard_charge_percentage": 71.0000, "estimated_amount": 3260, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1262.87, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4592.25, "estimated_amount": 4592, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4592.25, "estimated_amount": 4592, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4592.25, "estimated_amount": 4592, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 4390.88, "estimated_amount": 4390, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3991.71, "estimated_amount": 3991, "methodology": "fee schedule" }]}]} , { "description": "Revj reconstructed breast", "code_information": [ { "code": "19380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26087, "discounted_cash": 8837,"minimum": 785,"maximum": 21652.2,"payers_information":[{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 873.21, "estimated_amount": 873, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 5217.4, "standard_charge_percentage": 20.0000, "estimated_amount": 5217, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 11012.9, "estimated_amount": 11012, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7002.04, "estimated_amount": 7002, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 8869.58, "standard_charge_percentage": 34.0000, "estimated_amount": 8869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 5150, "estimated_amount": 5150, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 20869.6, "standard_charge_percentage": 80.0000, "estimated_amount": 20869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7138.01, "estimated_amount": 7138, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 6662.14, "estimated_amount": 6662, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 20869.6, "standard_charge_percentage": 80.0000, "estimated_amount": 20869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 20869.6, "standard_charge_percentage": 80.0000, "estimated_amount": 20869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20869.6, "standard_charge_percentage": 80.0000, "estimated_amount": 20869, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 19565.3, "standard_charge_percentage": 75.0000, "estimated_amount": 19565, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 8497.63, "estimated_amount": 8497, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7138.01, "estimated_amount": 7138, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 10537.1, "estimated_amount": 10537, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 7817.81, "estimated_amount": 7817, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 5713.05, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 5713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 10537.1, "estimated_amount": 10537, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 7477.91, "estimated_amount": 7477, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4289.37, "estimated_amount": 4289, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 873.21, "estimated_amount": 873, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7002.04, "estimated_amount": 7002, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 11687, "estimated_amount": 11687, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4289.37, "estimated_amount": 4289, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 18521.8, "standard_charge_percentage": 71.0000, "estimated_amount": 18521, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7138.01, "estimated_amount": 7138, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 16956.5, "standard_charge_percentage": 65.0000, "estimated_amount": 16956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 7173.93, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 7173, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8157.72, "estimated_amount": 8157, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 9177.43, "estimated_amount": 9177, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 21652.2, "standard_charge_percentage": 83.0000, "estimated_amount": 21652, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 9517.34, "estimated_amount": 9517, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 5713.05, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 5713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11102.7, "estimated_amount": 11102, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 10869, "estimated_amount": 10868, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 15505.1, "estimated_amount": 15505, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 10197.2, "estimated_amount": 10197, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 18260.9, "standard_charge_percentage": 70.0000, "estimated_amount": 18260, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 20869.6, "standard_charge_percentage": 80.0000, "estimated_amount": 20869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7826.1, "standard_charge_percentage": 30.0000, "estimated_amount": 7826, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7002.04, "estimated_amount": 7002, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 5713.05, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 5713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4085.11, "estimated_amount": 4085, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 785, "estimated_amount": 785, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7138.01, "estimated_amount": 7138, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 6798.1, "estimated_amount": 6798, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 6458.19, "estimated_amount": 6458, "methodology": "fee schedule" }]}]} , { "description": "Explore wound neck", "code_information": [ { "code": "20100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14698, "discounted_cash": 690,"minimum": 365,"maximum": 12199.3,"payers_information":[{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 530.85, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 530.85, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 10288.6, "standard_charge_percentage": 70.0000, "estimated_amount": 10288, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 11758.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3218.86, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 637.02, "estimated_amount": 637, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 530.85, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 530.85, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1211.55, "estimated_amount": 1211, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 583.93, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 661.77, "estimated_amount": 661, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 530.85, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 546.78, "estimated_amount": 546, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 546.78, "estimated_amount": 546, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3218.86, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3218, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 504.31, "estimated_amount": 504, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 530.85, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11758.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11758, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 12199.3, "standard_charge_percentage": 83.0000, "estimated_amount": 12199, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 530.85, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 530.85, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 11758.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 557.39, "estimated_amount": 557, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3836.18, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3836, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 610.48, "estimated_amount": 610, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 530.85, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 661.77, "estimated_amount": 661, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 557.39, "estimated_amount": 557, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 822.82, "estimated_amount": 822, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2939.6, "standard_charge_percentage": 20.0000, "estimated_amount": 2939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4997.32, "standard_charge_percentage": 34.0000, "estimated_amount": 4997, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4703.36, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 4703, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1339.11, "estimated_amount": 1339, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 530.85, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1237.6, "estimated_amount": 1237, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 743.19, "estimated_amount": 743, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 530.85, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 530.85, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 716.65, "estimated_amount": 716, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1210.76, "estimated_amount": 1210, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4041.95, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9553.7, "standard_charge_percentage": 65.0000, "estimated_amount": 9553, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 7099.13, "standard_charge_percentage": 48.3000, "estimated_amount": 7099, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3218.86, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3218, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1339.11, "estimated_amount": 1339, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 796.27, "estimated_amount": 796, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 530.85, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 557.39, "estimated_amount": 557, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 11023.5, "standard_charge_percentage": 75.0000, "estimated_amount": 11023, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 663.56, "estimated_amount": 663, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 822.82, "estimated_amount": 822, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 10435.6, "standard_charge_percentage": 71.0000, "estimated_amount": 10435, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 546.78, "estimated_amount": 546, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 530.85, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 530.85, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 11758.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 530.85, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11758.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11758, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 859.98, "estimated_amount": 859, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 557.39, "estimated_amount": 557, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4409.4, "standard_charge_percentage": 30.0000, "estimated_amount": 4409, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 530.85, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 530.85, "estimated_amount": 530, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1275.34, "estimated_amount": 1275, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1302.74, "estimated_amount": 1302, "methodology": "case rate" }]}]} , { "description": "Explore wound extremity", "code_information": [ { "code": "20103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15240, "discounted_cash": 2195,"minimum": 365,"maximum": 12649.2,"payers_information":[{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3337.56, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3337, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5181.6, "standard_charge_percentage": 34.0000, "estimated_amount": 5181, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9906, "standard_charge_percentage": 65.0000, "estimated_amount": 9906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12192, "standard_charge_percentage": 80.0000, "estimated_amount": 12192, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4876.8, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 4876, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 12192, "standard_charge_percentage": 80.0000, "estimated_amount": 12192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 586, "estimated_amount": 586, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3977.64, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3977, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 12649.2, "standard_charge_percentage": 83.0000, "estimated_amount": 12649, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 10820.4, "standard_charge_percentage": 71.0000, "estimated_amount": 10820, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 10668, "standard_charge_percentage": 70.0000, "estimated_amount": 10668, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 503.37, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4191, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 12192, "standard_charge_percentage": 80.0000, "estimated_amount": 12192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3048, "standard_charge_percentage": 20.0000, "estimated_amount": 3048, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 11430, "standard_charge_percentage": 75.0000, "estimated_amount": 11430, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 12192, "standard_charge_percentage": 80.0000, "estimated_amount": 12192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4572, "standard_charge_percentage": 30.0000, "estimated_amount": 4572, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12192, "standard_charge_percentage": 80.0000, "estimated_amount": 12192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1211.55, "estimated_amount": 1211, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 586, "estimated_amount": 586, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1237.6, "estimated_amount": 1237, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3337.56, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3337, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1302.74, "estimated_amount": 1302, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 479.4, "estimated_amount": 479, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3337.56, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3337, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3888, "discounted_cash": 3878,"minimum": 318.52,"maximum": 3888,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2527.2, "standard_charge_percentage": 65.0000, "estimated_amount": 2527, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3110.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3110, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3110.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3110, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 3888, "estimated_amount": 3888, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2760.48, "standard_charge_percentage": 71.0000, "estimated_amount": 2760, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1014.77, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1014, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1166.4, "standard_charge_percentage": 30.0000, "estimated_amount": 1166, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1321.92, "standard_charge_percentage": 34.0000, "estimated_amount": 1321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 851.47, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 851, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3227.04, "standard_charge_percentage": 83.0000, "estimated_amount": 3227, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 2916, "standard_charge_percentage": 75.0000, "estimated_amount": 2916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 318.52, "estimated_amount": 318, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 3888, "estimated_amount": 3888, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3110.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3110, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3888, "estimated_amount": 3888, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 3888, "estimated_amount": 3888, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 3888, "estimated_amount": 3888, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3110.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3110, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 3888, "estimated_amount": 3888, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3110.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3110, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1069.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1069, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 851.47, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 851, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 3888, "estimated_amount": 3888, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3888, "estimated_amount": 3888, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 3888, "estimated_amount": 3888, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 318.52, "estimated_amount": 318, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 777.6, "standard_charge_percentage": 20.0000, "estimated_amount": 777, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 851.47, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 851, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3888, "estimated_amount": 3888, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 3888, "estimated_amount": 3888, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2721.6, "standard_charge_percentage": 70.0000, "estimated_amount": 2721, "methodology": "percent of total billed charges" }]}]} , { "description": "Bone biopsy trocarndl supfc", "code_information": [ { "code": "20220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3100, "discounted_cash": 2195,"minimum": 229.31,"maximum": 3100,"payers_information":[{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 678.9, "standard_charge_percentage": 21.9000, "estimated_amount": 678, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 852.5, "standard_charge_percentage": 27.5000, "estimated_amount": 852, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3100, "estimated_amount": 3100, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2201, "standard_charge_percentage": 71.0000, "estimated_amount": 2201, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1054, "standard_charge_percentage": 34.0000, "estimated_amount": 1054, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 2480, "standard_charge_percentage": 80.0000, "estimated_amount": 2480, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 2542, "standard_charge_percentage": 82.0000, "estimated_amount": 2542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1262.82, "estimated_amount": 1262, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2480, "standard_charge_percentage": 80.0000, "estimated_amount": 2480, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 900.41, "estimated_amount": 900, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 2480, "standard_charge_percentage": 80.0000, "estimated_amount": 2480, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 678.9, "standard_charge_percentage": 21.9000, "estimated_amount": 678, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1442, "estimated_amount": 1442, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2170, "standard_charge_percentage": 70.0000, "estimated_amount": 2170, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 678.9, "standard_charge_percentage": 21.9000, "estimated_amount": 678, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 930, "standard_charge_percentage": 30.0000, "estimated_amount": 930, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 620, "standard_charge_percentage": 20.0000, "estimated_amount": 620, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 809.1, "standard_charge_percentage": 26.1000, "estimated_amount": 809, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 2325, "standard_charge_percentage": 75.0000, "estimated_amount": 2325, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 900.41, "estimated_amount": 900, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2015, "standard_charge_percentage": 65.0000, "estimated_amount": 2015, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 229.31, "estimated_amount": 229, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1174.42, "estimated_amount": 1174, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 229.31, "estimated_amount": 229, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 2573, "standard_charge_percentage": 83.0000, "estimated_amount": 2573, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2480, "standard_charge_percentage": 80.0000, "estimated_amount": 2480, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1199.68, "estimated_amount": 1199, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 857.53, "estimated_amount": 857, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 2480, "standard_charge_percentage": 80.0000, "estimated_amount": 2480, "methodology": "percent of total billed charges" }]}]} , { "description": "Bone biopsy trocarndl deep", "code_information": [ { "code": "20225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3696, "discounted_cash": 2195,"minimum": 373.42,"maximum": 3696,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 2956.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2402.4, "standard_charge_percentage": 65.0000, "estimated_amount": 2402, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2956.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1108.8, "standard_charge_percentage": 30.0000, "estimated_amount": 1108, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 2956.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2956, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 809.42, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 809, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1996.05, "estimated_amount": 1996, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 373.42, "estimated_amount": 373, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2587.2, "standard_charge_percentage": 70.0000, "estimated_amount": 2587, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 809.42, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 809, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 739.2, "standard_charge_percentage": 20.0000, "estimated_amount": 739, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 373.42, "estimated_amount": 373, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 2956.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 2772, "standard_charge_percentage": 75.0000, "estimated_amount": 2772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2624.16, "standard_charge_percentage": 71.0000, "estimated_amount": 2624, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1016.4, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1016, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3696, "estimated_amount": 3696, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1954.03, "estimated_amount": 1954, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1256.64, "standard_charge_percentage": 34.0000, "estimated_amount": 1256, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3067.68, "standard_charge_percentage": 83.0000, "estimated_amount": 3067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2956.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3696, "estimated_amount": 3696, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 964.66, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 964, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2101.11, "estimated_amount": 2101, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 809.42, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 809, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" }]}]} , { "description": "Bone biopsy open deep", "code_information": [ { "code": "20245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12943.7, "discounted_cash": 3878,"minimum": 369.25,"maximum": 10743.3,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3559.51, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3559, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3378.3, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3378, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2588.73, "standard_charge_percentage": 20.0000, "estimated_amount": 2588, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8413.39, "standard_charge_percentage": 65.0000, "estimated_amount": 8413, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10354.9, "standard_charge_percentage": 80.0000, "estimated_amount": 10354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10354.9, "standard_charge_percentage": 80.0000, "estimated_amount": 10354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2834.66, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2834, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3883.1, "standard_charge_percentage": 30.0000, "estimated_amount": 3883, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9060.57, "standard_charge_percentage": 70.0000, "estimated_amount": 9060, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10354.9, "standard_charge_percentage": 80.0000, "estimated_amount": 10354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4400.85, "standard_charge_percentage": 34.0000, "estimated_amount": 4400, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9707.75, "standard_charge_percentage": 75.0000, "estimated_amount": 9707, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6192.56, "estimated_amount": 6192, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2834.66, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2834, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10354.9, "standard_charge_percentage": 80.0000, "estimated_amount": 10354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9190.01, "standard_charge_percentage": 71.0000, "estimated_amount": 9190, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5759.08, "estimated_amount": 5759, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10354.9, "standard_charge_percentage": 80.0000, "estimated_amount": 10354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5882.93, "estimated_amount": 5882, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10743.3, "standard_charge_percentage": 83.0000, "estimated_amount": 10743, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 369.25, "estimated_amount": 369, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 369.25, "estimated_amount": 369, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2834.66, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2834, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" }]}]} , { "description": "Removal Of Foreign Body", "code_information": [ { "code": "20525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8528, "discounted_cash": 3878,"minimum": 481.69,"maximum": 7078.24,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 481.69, "estimated_amount": 481, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2345.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2345, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5543.2, "standard_charge_percentage": 65.0000, "estimated_amount": 5543, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2225.81, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2225, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6396, "standard_charge_percentage": 75.0000, "estimated_amount": 6396, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2899.52, "standard_charge_percentage": 34.0000, "estimated_amount": 2899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5882.93, "estimated_amount": 5882, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 481.69, "estimated_amount": 481, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6192.56, "estimated_amount": 6192, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2558.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2558, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1705.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1705, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7078.24, "standard_charge_percentage": 83.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6054.88, "standard_charge_percentage": 71.0000, "estimated_amount": 6054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5759.08, "estimated_amount": 5759, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5969.6, "standard_charge_percentage": 70.0000, "estimated_amount": 5969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7175, "discounted_cash": 400,"minimum": 60.74,"maximum": 5955.25,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1872.67, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1872, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 338.48, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2439.5, "standard_charge_percentage": 34.0000, "estimated_amount": 2439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5740, "standard_charge_percentage": 80.0000, "estimated_amount": 5740, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4663.75, "standard_charge_percentage": 65.0000, "estimated_amount": 4663, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 324.6, "estimated_amount": 324, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 324.6, "estimated_amount": 324, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 430.79, "estimated_amount": 430, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 369.25, "estimated_amount": 369, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1571.33, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1571, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 353.87, "estimated_amount": 353, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1571.33, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1571, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 498.49, "estimated_amount": 498, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 476.95, "estimated_amount": 476, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1435, "standard_charge_percentage": 20.0000, "estimated_amount": 1435, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 60.74, "estimated_amount": 60, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5740, "standard_charge_percentage": 80.0000, "estimated_amount": 5740, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 649.03, "estimated_amount": 649, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 461.56, "estimated_amount": 461, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2152.5, "standard_charge_percentage": 30.0000, "estimated_amount": 2152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 476.95, "estimated_amount": 476, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 292.32, "estimated_amount": 292, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 415.41, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5740, "standard_charge_percentage": 80.0000, "estimated_amount": 5740, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 697.88, "estimated_amount": 697, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 60.74, "estimated_amount": 60, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 301.56, "estimated_amount": 301, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5022.5, "standard_charge_percentage": 70.0000, "estimated_amount": 5022, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 701.82, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5740, "standard_charge_percentage": 80.0000, "estimated_amount": 5740, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5381.25, "standard_charge_percentage": 75.0000, "estimated_amount": 5381, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2296, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 662.99, "estimated_amount": 662, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 384.64, "estimated_amount": 384, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1571.33, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1571, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5740, "standard_charge_percentage": 80.0000, "estimated_amount": 5740, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1973.13, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1973, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 5094.25, "standard_charge_percentage": 71.0000, "estimated_amount": 5094, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5955.25, "standard_charge_percentage": 83.0000, "estimated_amount": 5955, "methodology": "percent of total billed charges" }]}]} , { "description": "INJ TRIGGER POINT 12 MUSCL", "code_information": [ { "code": "20552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3699, "discounted_cash": 400,"minimum": 53.86,"maximum": 3699,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 476.95, "estimated_amount": 476, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2959.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 353.87, "estimated_amount": 353, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 649.03, "estimated_amount": 649, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 739.8, "standard_charge_percentage": 20.0000, "estimated_amount": 739, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 810.08, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 810, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 965.44, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 965, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1109.7, "standard_charge_percentage": 30.0000, "estimated_amount": 1109, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 292.32, "estimated_amount": 292, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 697.88, "estimated_amount": 697, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1257.66, "standard_charge_percentage": 34.0000, "estimated_amount": 1257, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 301.56, "estimated_amount": 301, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1017.23, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1017, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3070.17, "standard_charge_percentage": 83.0000, "estimated_amount": 3070, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 2959.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 338.48, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2626.29, "standard_charge_percentage": 71.0000, "estimated_amount": 2626, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2404.35, "standard_charge_percentage": 65.0000, "estimated_amount": 2404, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2589.3, "standard_charge_percentage": 70.0000, "estimated_amount": 2589, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 2774.25, "standard_charge_percentage": 75.0000, "estimated_amount": 2774, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 810.08, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 810, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 476.95, "estimated_amount": 476, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 2959.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2959.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3699, "estimated_amount": 3699, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 415.41, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 324.6, "estimated_amount": 324, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1183.68, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 1183, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 662.99, "estimated_amount": 662, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 369.25, "estimated_amount": 369, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 461.56, "estimated_amount": 461, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 430.79, "estimated_amount": 430, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 324.6, "estimated_amount": 324, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 2959.2, "standard_charge_percentage": 80.0000, "estimated_amount": 2959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 701.82, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 384.64, "estimated_amount": 384, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 498.49, "estimated_amount": 498, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 53.86, "estimated_amount": 53, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 810.08, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 810, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 53.86, "estimated_amount": 53, "methodology": "fee schedule" }]}]} , { "description": "INJECT TRIGGER POINTS 3>", "code_information": [ { "code": "20553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6552, "discounted_cash": 400,"minimum": 62.08,"maximum": 5438.16,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 476.95, "estimated_amount": 476, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 415.41, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1310.4, "standard_charge_percentage": 20.0000, "estimated_amount": 1310, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1434.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1434, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4914, "standard_charge_percentage": 75.0000, "estimated_amount": 4914, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1434.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1434, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 498.49, "estimated_amount": 498, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 292.32, "estimated_amount": 292, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5438.16, "standard_charge_percentage": 83.0000, "estimated_amount": 5438, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4651.92, "standard_charge_percentage": 71.0000, "estimated_amount": 4651, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 701.82, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 353.87, "estimated_amount": 353, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 62.08, "estimated_amount": 62, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 384.64, "estimated_amount": 384, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 430.79, "estimated_amount": 430, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4586.4, "standard_charge_percentage": 70.0000, "estimated_amount": 4586, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 662.99, "estimated_amount": 662, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1434.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1434, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 324.6, "estimated_amount": 324, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 324.6, "estimated_amount": 324, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1801.8, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1801, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 649.03, "estimated_amount": 649, "methodology": "case rate" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2096.64, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2096, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 697.88, "estimated_amount": 697, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5241.6, "standard_charge_percentage": 80.0000, "estimated_amount": 5241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4258.8, "standard_charge_percentage": 65.0000, "estimated_amount": 4258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 476.95, "estimated_amount": 476, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5241.6, "standard_charge_percentage": 80.0000, "estimated_amount": 5241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 369.25, "estimated_amount": 369, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1710.07, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1710, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 301.56, "estimated_amount": 301, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 461.56, "estimated_amount": 461, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1965.6, "standard_charge_percentage": 30.0000, "estimated_amount": 1965, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5241.6, "standard_charge_percentage": 80.0000, "estimated_amount": 5241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5241.6, "standard_charge_percentage": 80.0000, "estimated_amount": 5241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 62.08, "estimated_amount": 62, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2227.68, "standard_charge_percentage": 34.0000, "estimated_amount": 2227, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5241.6, "standard_charge_percentage": 80.0000, "estimated_amount": 5241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 338.48, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" }]}]} , { "description": "DRAININJECT JOINTBURSA", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 828, "discounted_cash": 400,"minimum": 55.84,"maximum": 828,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 384.64, "estimated_amount": 384, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 181.33, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 264.96, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 292.32, "estimated_amount": 292, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 227.7, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 227, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 461.56, "estimated_amount": 461, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 662.4, "standard_charge_percentage": 80.0000, "estimated_amount": 662, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 430.79, "estimated_amount": 430, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 662.4, "standard_charge_percentage": 80.0000, "estimated_amount": 662, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 301.56, "estimated_amount": 301, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 415.41, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 649.03, "estimated_amount": 649, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 701.82, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 248.4, "standard_charge_percentage": 30.0000, "estimated_amount": 248, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 662.4, "standard_charge_percentage": 80.0000, "estimated_amount": 662, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 587.88, "standard_charge_percentage": 71.0000, "estimated_amount": 587, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 55.84, "estimated_amount": 55, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 476.95, "estimated_amount": 476, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 828, "estimated_amount": 828, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 369.25, "estimated_amount": 369, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 55.84, "estimated_amount": 55, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 538.2, "standard_charge_percentage": 65.0000, "estimated_amount": 538, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 281.52, "standard_charge_percentage": 34.0000, "estimated_amount": 281, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 621, "standard_charge_percentage": 75.0000, "estimated_amount": 621, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 338.48, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 662.99, "estimated_amount": 662, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 662.4, "standard_charge_percentage": 80.0000, "estimated_amount": 662, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 324.6, "estimated_amount": 324, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 498.49, "estimated_amount": 498, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 476.95, "estimated_amount": 476, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 687.24, "standard_charge_percentage": 83.0000, "estimated_amount": 687, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 353.87, "estimated_amount": 353, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 324.6, "estimated_amount": 324, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 579.6, "standard_charge_percentage": 70.0000, "estimated_amount": 579, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 662.4, "standard_charge_percentage": 80.0000, "estimated_amount": 662, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 181.33, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 828, "estimated_amount": 828, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 697.88, "estimated_amount": 697, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 181.33, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 181, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 216.11, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 216, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 165.6, "standard_charge_percentage": 20.0000, "estimated_amount": 165, "methodology": "percent of total billed charges" }]}]} , { "description": "DRAININJECT JOINTBURSA", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1147, "discounted_cash": 400,"minimum": 56.82,"maximum": 1147,"payers_information":[{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 389.98, "standard_charge_percentage": 34.0000, "estimated_amount": 389, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 301.56, "estimated_amount": 301, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 353.87, "estimated_amount": 353, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 814.37, "standard_charge_percentage": 71.0000, "estimated_amount": 814, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 461.56, "estimated_amount": 461, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 251.19, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1147, "estimated_amount": 1147, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 299.37, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 662.99, "estimated_amount": 662, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 251.19, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 476.95, "estimated_amount": 476, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 917.6, "standard_charge_percentage": 80.0000, "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 476.95, "estimated_amount": 476, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 649.03, "estimated_amount": 649, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 344.1, "standard_charge_percentage": 30.0000, "estimated_amount": 344, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 860.25, "standard_charge_percentage": 75.0000, "estimated_amount": 860, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 338.48, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 430.79, "estimated_amount": 430, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 324.6, "estimated_amount": 324, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 415.41, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 56.82, "estimated_amount": 56, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 952.01, "standard_charge_percentage": 83.0000, "estimated_amount": 952, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 292.32, "estimated_amount": 292, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 324.6, "estimated_amount": 324, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 917.6, "standard_charge_percentage": 80.0000, "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 56.82, "estimated_amount": 56, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 369.25, "estimated_amount": 369, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 917.6, "standard_charge_percentage": 80.0000, "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 251.19, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 251, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 384.64, "estimated_amount": 384, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 917.6, "standard_charge_percentage": 80.0000, "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 917.6, "standard_charge_percentage": 80.0000, "estimated_amount": 917, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 802.9, "standard_charge_percentage": 70.0000, "estimated_amount": 802, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 315.43, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 315, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 701.82, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 745.55, "standard_charge_percentage": 65.0000, "estimated_amount": 745, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 367.04, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 367, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 229.4, "standard_charge_percentage": 20.0000, "estimated_amount": 229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 697.88, "estimated_amount": 697, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1147, "estimated_amount": 1147, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 498.49, "estimated_amount": 498, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" }]}]} , { "description": "DRAININJECT JOINTBURSA", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1424, "discounted_cash": 400,"minimum": 68.63,"maximum": 1424,"payers_information":[{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 284.8, "standard_charge_percentage": 20.0000, "estimated_amount": 284, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1139.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 68.63, "estimated_amount": 68, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 476.95, "estimated_amount": 476, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 498.49, "estimated_amount": 498, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 324.6, "estimated_amount": 324, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 701.82, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 353.87, "estimated_amount": 353, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 996.8, "standard_charge_percentage": 70.0000, "estimated_amount": 996, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 476.95, "estimated_amount": 476, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1139.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 301.56, "estimated_amount": 301, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 925.6, "standard_charge_percentage": 65.0000, "estimated_amount": 925, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 430.79, "estimated_amount": 430, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1139.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 697.88, "estimated_amount": 697, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 68.63, "estimated_amount": 68, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 391.6, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 391, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1068, "standard_charge_percentage": 75.0000, "estimated_amount": 1068, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 427.2, "standard_charge_percentage": 30.0000, "estimated_amount": 427, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 371.66, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 371, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 311.86, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 338.48, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 369.25, "estimated_amount": 369, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 415.41, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1139.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 455.68, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1139.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 309.14, "estimated_amount": 309, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 461.56, "estimated_amount": 461, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1011.04, "standard_charge_percentage": 71.0000, "estimated_amount": 1011, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 662.99, "estimated_amount": 662, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 292.32, "estimated_amount": 292, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 1181.92, "standard_charge_percentage": 83.0000, "estimated_amount": 1181, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 311.86, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 311.86, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 311, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 649.03, "estimated_amount": 649, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1424, "estimated_amount": 1424, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 324.6, "estimated_amount": 324, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 384.64, "estimated_amount": 384, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 484.16, "standard_charge_percentage": 34.0000, "estimated_amount": 484, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Arthrocentesis Aspir&/Inj Major Jt/Bursa W/Us", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1045, "discounted_cash": 400,"minimum": 103.19,"maximum": 1045,"payers_information":[{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 555.94, "standard_charge_percentage": 53.2000, "estimated_amount": 555, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 287.38, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 287, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 679.25, "standard_charge_percentage": 65.0000, "estimated_amount": 679, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 576.17, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 576.17, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 783.75, "standard_charge_percentage": 75.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1045, "estimated_amount": 1045, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 836, "standard_charge_percentage": 80.0000, "estimated_amount": 836, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 338.48, "estimated_amount": 338, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 415.41, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 103.19, "estimated_amount": 103, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 334.4, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 334, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 369.25, "estimated_amount": 369, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 430.79, "estimated_amount": 430, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 576.17, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 604.98, "estimated_amount": 604, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 292.32, "estimated_amount": 292, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 103.19, "estimated_amount": 103, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 384.64, "estimated_amount": 384, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 836, "standard_charge_percentage": 80.0000, "estimated_amount": 836, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 209, "standard_charge_percentage": 20.0000, "estimated_amount": 209, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 313.5, "standard_charge_percentage": 30.0000, "estimated_amount": 313, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 528.14, "standard_charge_percentage": 53.2000, "estimated_amount": 528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 836, "standard_charge_percentage": 80.0000, "estimated_amount": 836, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 476.95, "estimated_amount": 476, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 836, "standard_charge_percentage": 80.0000, "estimated_amount": 836, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 272.75, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 272, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 461.56, "estimated_amount": 461, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 228.85, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 355.3, "standard_charge_percentage": 34.0000, "estimated_amount": 355, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 261.25, "standard_charge_percentage": 25.0000, "estimated_amount": 261, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 353.87, "estimated_amount": 353, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 836, "standard_charge_percentage": 80.0000, "estimated_amount": 836, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 701.82, "estimated_amount": 701, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 731.5, "standard_charge_percentage": 70.0000, "estimated_amount": 731, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 576.17, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 316.94, "estimated_amount": 316, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 741.95, "standard_charge_percentage": 71.0000, "estimated_amount": 741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 301.56, "estimated_amount": 301, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 476.95, "estimated_amount": 476, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 228.85, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 604.98, "estimated_amount": 604, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1045, "estimated_amount": 1045, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 307.71, "estimated_amount": 307, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 498.49, "estimated_amount": 498, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 228.85, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 228, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 576.17, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 576.17, "estimated_amount": 576, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 323.1, "estimated_amount": 323, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 867.35, "standard_charge_percentage": 83.0000, "estimated_amount": 867, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 517.02, "standard_charge_percentage": 53.2000, "estimated_amount": 517, "methodology": "percent of total billed charges" }]}]} , { "description": "REMOVAL IMPLANT SUPERFICIAL", "code_information": [ { "code": "20670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6613.68, "discounted_cash": 2195,"minimum": 355.2,"maximum": 5489.35,"payers_information":[{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 3052.42, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3342.55, "standard_charge_percentage": 53.2000, "estimated_amount": 3342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4695.71, "standard_charge_percentage": 71.0000, "estimated_amount": 4695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5290.94, "standard_charge_percentage": 80.0000, "estimated_amount": 5290, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5290.94, "standard_charge_percentage": 80.0000, "estimated_amount": 5290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1818.76, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1818, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1448.4, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1448, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1448.4, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1448, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 3052.42, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4629.58, "standard_charge_percentage": 70.0000, "estimated_amount": 4629, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 355.2, "estimated_amount": 355, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5290.94, "standard_charge_percentage": 80.0000, "estimated_amount": 5290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1726.17, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1726, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 3272.18, "standard_charge_percentage": 53.2000, "estimated_amount": 3272, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1442, "estimated_amount": 1442, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5290.94, "standard_charge_percentage": 80.0000, "estimated_amount": 5290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4298.89, "standard_charge_percentage": 65.0000, "estimated_amount": 4298, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 3518.48, "standard_charge_percentage": 53.2000, "estimated_amount": 3518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 355.2, "estimated_amount": 355, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4960.26, "standard_charge_percentage": 75.0000, "estimated_amount": 4960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1322.74, "standard_charge_percentage": 20.0000, "estimated_amount": 1322, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2248.65, "standard_charge_percentage": 34.0000, "estimated_amount": 2248, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1984.1, "standard_charge_percentage": 30.0000, "estimated_amount": 1984, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1448.4, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1448, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5489.35, "standard_charge_percentage": 83.0000, "estimated_amount": 5489, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5290.94, "standard_charge_percentage": 80.0000, "estimated_amount": 5290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" }]}]} , { "description": "REMOVAL OF IMPLANT DEEP", "code_information": [ { "code": "20680", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15632, "discounted_cash": 3878,"minimum": 558,"maximum": 12974.6,"payers_information":[{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3423.41, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 12505.6, "standard_charge_percentage": 80.0000, "estimated_amount": 12505, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 626.36, "estimated_amount": 626, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 11098.7, "standard_charge_percentage": 71.0000, "estimated_amount": 11098, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 3052.42, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3423.41, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4298.8, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4298, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4689.6, "standard_charge_percentage": 30.0000, "estimated_amount": 4689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3423.41, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3423, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 10942.4, "standard_charge_percentage": 70.0000, "estimated_amount": 10942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 3052.42, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12505.6, "standard_charge_percentage": 80.0000, "estimated_amount": 12505, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 12505.6, "standard_charge_percentage": 80.0000, "estimated_amount": 12505, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 7734.09, "standard_charge_percentage": 53.2000, "estimated_amount": 7734, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4079.95, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4079, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7900.41, "standard_charge_percentage": 53.2000, "estimated_amount": 7900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 11724, "standard_charge_percentage": 75.0000, "estimated_amount": 11724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 12505.6, "standard_charge_percentage": 80.0000, "estimated_amount": 12505, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12505.6, "standard_charge_percentage": 80.0000, "estimated_amount": 12505, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 626.36, "estimated_amount": 626, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 12974.6, "standard_charge_percentage": 83.0000, "estimated_amount": 12974, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 10160.8, "standard_charge_percentage": 65.0000, "estimated_amount": 10160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3126.4, "standard_charge_percentage": 20.0000, "estimated_amount": 3126, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5314.88, "standard_charge_percentage": 34.0000, "estimated_amount": 5314, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 8316.22, "standard_charge_percentage": 53.2000, "estimated_amount": 8316, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" }]}]} , { "description": "APPL UNIPLN UNI EXT FIXJ SYS", "code_information": [ { "code": "20690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9654, "discounted_cash": 9680,"minimum": 488,"maximum": 9654,"payers_information":[{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2896.2, "standard_charge_percentage": 30.0000, "estimated_amount": 2896, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 653.39, "estimated_amount": 653, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3282.36, "standard_charge_percentage": 34.0000, "estimated_amount": 3282, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 9654, "estimated_amount": 9654, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2519.69, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2519, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6854.34, "standard_charge_percentage": 71.0000, "estimated_amount": 6854, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 7240.5, "standard_charge_percentage": 75.0000, "estimated_amount": 7240, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 7755.38, "estimated_amount": 7755, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 7723.2, "standard_charge_percentage": 80.0000, "estimated_amount": 7723, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7723.2, "standard_charge_percentage": 80.0000, "estimated_amount": 7723, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2114.23, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 653.39, "estimated_amount": 653, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 3052.42, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 9654, "estimated_amount": 9654, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 8012.82, "standard_charge_percentage": 83.0000, "estimated_amount": 8012, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 9654, "estimated_amount": 9654, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 6275.1, "standard_charge_percentage": 65.0000, "estimated_amount": 6275, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2114.23, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 9654, "estimated_amount": 9654, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7723.2, "standard_charge_percentage": 80.0000, "estimated_amount": 7723, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 9654, "estimated_amount": 9654, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 3052.42, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 9654, "estimated_amount": 9654, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 7723.2, "standard_charge_percentage": 80.0000, "estimated_amount": 7723, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 7723.2, "standard_charge_percentage": 80.0000, "estimated_amount": 7723, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2114.23, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2654.85, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2654, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7367.61, "estimated_amount": 7367, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6757.8, "standard_charge_percentage": 70.0000, "estimated_amount": 6757, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1930.8, "standard_charge_percentage": 20.0000, "estimated_amount": 1930, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 9654, "estimated_amount": 9654, "methodology": "fee schedule" }]}]} , { "description": "APPL MLTPLN UNI EXT FIXJ SYS", "code_information": [ { "code": "20692", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6375, "discounted_cash": 17436,"minimum": 558,"maximum": 6375,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 3052.42, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1224.56, "estimated_amount": 1224, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1663.88, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1663, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1396.13, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1396, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1275, "standard_charge_percentage": 20.0000, "estimated_amount": 1275, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2167.5, "standard_charge_percentage": 34.0000, "estimated_amount": 2167, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1396.13, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1396, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5100, "standard_charge_percentage": 80.0000, "estimated_amount": 5100, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5291.25, "standard_charge_percentage": 83.0000, "estimated_amount": 5291, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4462.5, "standard_charge_percentage": 70.0000, "estimated_amount": 4462, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1396.13, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1396, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5100, "standard_charge_percentage": 80.0000, "estimated_amount": 5100, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1753.13, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1753, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4526.25, "standard_charge_percentage": 71.0000, "estimated_amount": 4526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5100, "standard_charge_percentage": 80.0000, "estimated_amount": 5100, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5100, "standard_charge_percentage": 80.0000, "estimated_amount": 5100, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4143.75, "standard_charge_percentage": 65.0000, "estimated_amount": 4143, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1224.56, "estimated_amount": 1224, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 3052.42, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1912.5, "standard_charge_percentage": 30.0000, "estimated_amount": 1912, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5100, "standard_charge_percentage": 80.0000, "estimated_amount": 5100, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4781.25, "standard_charge_percentage": 75.0000, "estimated_amount": 4781, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 6375, "estimated_amount": 6375, "methodology": "fee schedule" }]}]} , { "description": "Rmvl Ext Fixj Sys Under Anes", "code_information": [ { "code": "20694", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12101, "discounted_cash": 2168,"minimum": 365,"maximum": 10043.8,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2650.12, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2650, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1442, "estimated_amount": 1442, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 9680.8, "standard_charge_percentage": 80.0000, "estimated_amount": 9680, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6437.73, "standard_charge_percentage": 53.2000, "estimated_amount": 6437, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 9680.8, "standard_charge_percentage": 80.0000, "estimated_amount": 9680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2420.2, "standard_charge_percentage": 20.0000, "estimated_amount": 2420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9680.8, "standard_charge_percentage": 80.0000, "estimated_amount": 9680, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9075.75, "standard_charge_percentage": 75.0000, "estimated_amount": 9075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5987.09, "standard_charge_percentage": 53.2000, "estimated_amount": 5987, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7865.65, "standard_charge_percentage": 65.0000, "estimated_amount": 7865, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3327.78, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3327, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 9680.8, "standard_charge_percentage": 80.0000, "estimated_amount": 9680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 458.68, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 3052.42, "estimated_amount": 3052, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10043.8, "standard_charge_percentage": 83.0000, "estimated_amount": 10043, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3630.3, "standard_charge_percentage": 30.0000, "estimated_amount": 3630, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9680.8, "standard_charge_percentage": 80.0000, "estimated_amount": 9680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2650.12, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2650, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3158.36, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3158, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2907.07, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4114.34, "standard_charge_percentage": 34.0000, "estimated_amount": 4114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2650.12, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2650, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 8591.71, "standard_charge_percentage": 71.0000, "estimated_amount": 8591, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 8470.7, "standard_charge_percentage": 70.0000, "estimated_amount": 8470, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6115.85, "standard_charge_percentage": 53.2000, "estimated_amount": 6115, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 458.68, "estimated_amount": 458, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 3052.42, "estimated_amount": 3052, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10961.5,"minimum": 136.15,"maximum": 9098.05,"payers_information":[{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7782.66, "standard_charge_percentage": 71.0000, "estimated_amount": 7782, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5423.31, "standard_charge_percentage": 53.2000, "estimated_amount": 5423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 2740.38, "standard_charge_percentage": 25.0000, "estimated_amount": 2740, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 422.13, "estimated_amount": 422, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3507.68, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 3507, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 402.03, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2860.95, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2860, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8769.2, "standard_charge_percentage": 80.0000, "estimated_amount": 8769, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 9098.05, "standard_charge_percentage": 83.0000, "estimated_amount": 9098, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 402.03, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 422.13, "estimated_amount": 422, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 136.15, "estimated_amount": 136, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 402.03, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7124.98, "standard_charge_percentage": 65.0000, "estimated_amount": 7124, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2400.57, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 5831.52, "standard_charge_percentage": 53.2000, "estimated_amount": 5831, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2400.57, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3726.91, "standard_charge_percentage": 34.0000, "estimated_amount": 3726, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8769.2, "standard_charge_percentage": 80.0000, "estimated_amount": 8769, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 8221.13, "standard_charge_percentage": 75.0000, "estimated_amount": 8221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 136.15, "estimated_amount": 136, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8769.2, "standard_charge_percentage": 80.0000, "estimated_amount": 8769, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3014.41, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3014, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 402.03, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5539.94, "standard_charge_percentage": 53.2000, "estimated_amount": 5539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 402.03, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8769.2, "standard_charge_percentage": 80.0000, "estimated_amount": 8769, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2400.57, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2192.3, "standard_charge_percentage": 20.0000, "estimated_amount": 2192, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 402.03, "estimated_amount": 402, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7673.05, "standard_charge_percentage": 70.0000, "estimated_amount": 7673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8769.2, "standard_charge_percentage": 80.0000, "estimated_amount": 8769, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3288.45, "standard_charge_percentage": 30.0000, "estimated_amount": 3288, "methodology": "percent of total billed charges" }]}]} , { "description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [ { "code": "20982", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8406, "discounted_cash": 17436,"minimum": 1169,"maximum": 8406,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2858.04, "standard_charge_percentage": 34.0000, "estimated_amount": 2858, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 3332.23, "estimated_amount": 3332, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1840.91, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 2101.5, "standard_charge_percentage": 25.0000, "estimated_amount": 2101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5463.9, "standard_charge_percentage": 65.0000, "estimated_amount": 5463, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6724.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 3332.23, "estimated_amount": 3332, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2521.8, "standard_charge_percentage": 30.0000, "estimated_amount": 2521, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1840.91, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1840, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6304.5, "standard_charge_percentage": 75.0000, "estimated_amount": 6304, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2689.92, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5884.2, "standard_charge_percentage": 70.0000, "estimated_amount": 5884, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1681.2, "standard_charge_percentage": 20.0000, "estimated_amount": 1681, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 5968.26, "standard_charge_percentage": 71.0000, "estimated_amount": 5968, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2311.65, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1840.91, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6724.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6724.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6724.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2193.97, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 6976.98, "standard_charge_percentage": 83.0000, "estimated_amount": 6976, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 8406, "estimated_amount": 8406, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6724.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6724, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "20985", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43449.1,"minimum": 158.4,"maximum": 36062.8,"payers_information":[{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 34759.3, "standard_charge_percentage": 80.0000, "estimated_amount": 34759, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 158.4, "estimated_amount": 158, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 13034.7, "standard_charge_percentage": 30.0000, "estimated_amount": 13034, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 32586.8, "standard_charge_percentage": 75.0000, "estimated_amount": 32586, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 21496.9, "standard_charge_percentage": 53.2000, "estimated_amount": 21496, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 34759.3, "standard_charge_percentage": 80.0000, "estimated_amount": 34759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 21959.2, "standard_charge_percentage": 53.2000, "estimated_amount": 21959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 23114.9, "standard_charge_percentage": 53.2000, "estimated_amount": 23114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 158.4, "estimated_amount": 158, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 34759.3, "standard_charge_percentage": 80.0000, "estimated_amount": 34759, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 36062.8, "standard_charge_percentage": 83.0000, "estimated_amount": 36062, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 28241.9, "standard_charge_percentage": 65.0000, "estimated_amount": 28241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 10862.3, "standard_charge_percentage": 25.0000, "estimated_amount": 10862, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 34759.3, "standard_charge_percentage": 80.0000, "estimated_amount": 34759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 9528, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 9528, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8889, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8889, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 30414.4, "standard_charge_percentage": 70.0000, "estimated_amount": 30414, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 34759.3, "standard_charge_percentage": 80.0000, "estimated_amount": 34759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 30848.9, "standard_charge_percentage": 71.0000, "estimated_amount": 30848, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 14772.7, "standard_charge_percentage": 34.0000, "estimated_amount": 14772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 8689.82, "standard_charge_percentage": 20.0000, "estimated_amount": 8689, "methodology": "percent of total billed charges" }]}]} , { "description": "EXC FACE LES SBQ 2 CM<", "code_information": [ { "code": "21012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17118, "discounted_cash": 2195,"minimum": 369.49,"maximum": 14207.9,"payers_information":[{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 14207.9, "standard_charge_percentage": 83.0000, "estimated_amount": 14207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 369.49, "estimated_amount": 369, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3748.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3748, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 9106.78, "standard_charge_percentage": 53.2000, "estimated_amount": 9106, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3748.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3748, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4467.8, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4467, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5135.4, "standard_charge_percentage": 30.0000, "estimated_amount": 5135, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8651.44, "standard_charge_percentage": 53.2000, "estimated_amount": 8651, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3748.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3748, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5820.12, "standard_charge_percentage": 34.0000, "estimated_amount": 5820, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4707.45, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4707, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 11126.7, "standard_charge_percentage": 65.0000, "estimated_amount": 11126, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 8469.3, "standard_charge_percentage": 53.2000, "estimated_amount": 8469, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 12153.8, "standard_charge_percentage": 71.0000, "estimated_amount": 12153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 369.49, "estimated_amount": 369, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 11982.6, "standard_charge_percentage": 70.0000, "estimated_amount": 11982, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 5477.76, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 5477, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3423.6, "standard_charge_percentage": 20.0000, "estimated_amount": 3423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 12838.5, "standard_charge_percentage": 75.0000, "estimated_amount": 12838, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" }]}]} , { "description": "CLOSED TX NOSE FX W STABLJ", "code_information": [ { "code": "21320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5448, "discounted_cash": 4394,"minimum": 221.34,"maximum": 5448,"payers_information":[{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3380.64, "estimated_amount": 3380, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3380.64, "estimated_amount": 3380, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3380.64, "estimated_amount": 3380, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4358.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4358, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3549.67, "estimated_amount": 3549, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5239.99, "estimated_amount": 5239, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3482.06, "estimated_amount": 3482, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1421.93, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1421, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 2167.24, "estimated_amount": 2167, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3549.67, "estimated_amount": 3549, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3380.64, "estimated_amount": 3380, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 5448, "estimated_amount": 5448, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3380.64, "estimated_amount": 3380, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3549.67, "estimated_amount": 3549, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3380.64, "estimated_amount": 3380, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5070.96, "estimated_amount": 5070, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3380.64, "estimated_amount": 3380, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4358.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4358, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3813.6, "standard_charge_percentage": 70.0000, "estimated_amount": 3813, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1193.11, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1193, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 4521.84, "standard_charge_percentage": 83.0000, "estimated_amount": 4521, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4086, "standard_charge_percentage": 75.0000, "estimated_amount": 4086, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3868.08, "standard_charge_percentage": 71.0000, "estimated_amount": 3868, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3380.64, "estimated_amount": 3380, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3541.2, "standard_charge_percentage": 65.0000, "estimated_amount": 3541, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4732.9, "estimated_amount": 4732, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3380.64, "estimated_amount": 3380, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3211.61, "estimated_amount": 3211, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1852.32, "standard_charge_percentage": 34.0000, "estimated_amount": 1852, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1193.11, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4358.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4358, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3380.64, "estimated_amount": 3380, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 221.34, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3380.64, "estimated_amount": 3380, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3380.64, "estimated_amount": 3380, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4358.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4358, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3482.06, "estimated_amount": 3482, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1193.11, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5448, "estimated_amount": 5448, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3549.67, "estimated_amount": 3549, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3380.64, "estimated_amount": 3380, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3482.06, "estimated_amount": 3482, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4563.86, "estimated_amount": 4563, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4225.8, "estimated_amount": 4225, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 2213.85, "estimated_amount": 2213, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4358.4, "standard_charge_percentage": 80.0000, "estimated_amount": 4358, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3380.64, "estimated_amount": 3380, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5239.99, "estimated_amount": 5239, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4056.77, "estimated_amount": 4056, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3718.7, "estimated_amount": 3718, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3380.64, "estimated_amount": 3380, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3887.74, "estimated_amount": 3887, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3380.64, "estimated_amount": 3380, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 221.34, "estimated_amount": 221, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3380.64, "estimated_amount": 3380, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3313.03, "estimated_amount": 3313, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2330.37, "estimated_amount": 2330, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1634.4, "standard_charge_percentage": 30.0000, "estimated_amount": 1634, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3380.64, "estimated_amount": 3380, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1498.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1498, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1089.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1089, "methodology": "percent of total billed charges" }]}]} , { "description": "Opn tx dprsd zygomatic arch", "code_information": [ { "code": "21356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13552, "discounted_cash": 8016,"minimum": 558,"maximum": 13552,"payers_information":[{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 7200, "estimated_amount": 7200, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 6783.26, "estimated_amount": 6783, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10841.6, "standard_charge_percentage": 80.0000, "estimated_amount": 10841, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10841.6, "standard_charge_percentage": 80.0000, "estimated_amount": 10841, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 572.81, "estimated_amount": 572, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 9558.23, "estimated_amount": 9558, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4336.64, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 4336, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 3283.13, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 3447.29, "estimated_amount": 3447, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10841.6, "standard_charge_percentage": 80.0000, "estimated_amount": 10841, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 10164, "standard_charge_percentage": 75.0000, "estimated_amount": 10164, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 3283.13, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9621.92, "standard_charge_percentage": 71.0000, "estimated_amount": 9621, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 9558.23, "estimated_amount": 9558, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 3283.13, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 7708.25, "estimated_amount": 7708, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6840, "estimated_amount": 6840, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 7091.59, "estimated_amount": 7091, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2967.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2967, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 6696, "estimated_amount": 6696, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4607.68, "standard_charge_percentage": 34.0000, "estimated_amount": 4607, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2967.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2967, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 6351.6, "estimated_amount": 6351, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3537.07, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3537, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 8324.91, "estimated_amount": 8324, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3726.8, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3726, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3283.13, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 6043.27, "estimated_amount": 6043, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 9989.89, "estimated_amount": 9989, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 6351.6, "estimated_amount": 6351, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 572.81, "estimated_amount": 572, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 7399.92, "estimated_amount": 7399, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 6351.6, "estimated_amount": 6351, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 5858.27, "estimated_amount": 5858, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 6474.93, "estimated_amount": 6474, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 13552, "estimated_amount": 13552, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 3283.13, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2967.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2967, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8808.8, "standard_charge_percentage": 65.0000, "estimated_amount": 8808, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10841.6, "standard_charge_percentage": 80.0000, "estimated_amount": 10841, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 3283.13, "estimated_amount": 3283, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 6474.93, "estimated_amount": 6474, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 6474.93, "estimated_amount": 6474, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2710.4, "standard_charge_percentage": 20.0000, "estimated_amount": 2710, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9486.4, "standard_charge_percentage": 70.0000, "estimated_amount": 9486, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 8633.24, "estimated_amount": 8633, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 9249.9, "estimated_amount": 9249, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 11248.2, "standard_charge_percentage": 83.0000, "estimated_amount": 11248, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 3447.29, "estimated_amount": 3447, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10841.6, "standard_charge_percentage": 80.0000, "estimated_amount": 10841, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 6474.93, "estimated_amount": 6474, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4065.6, "standard_charge_percentage": 30.0000, "estimated_amount": 4065, "methodology": "percent of total billed charges" }]}]} , { "description": "OPN TX ORBIT PERIORBTL IMPLT", "code_information": [ { "code": "21390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20440, "discounted_cash": 8016,"minimum": 839.33,"maximum": 16965.2,"payers_information":[{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 7399.92, "estimated_amount": 7399, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1090, "estimated_amount": 1090, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 839.33, "estimated_amount": 839, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 16352, "standard_charge_percentage": 80.0000, "estimated_amount": 16352, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 6474.93, "estimated_amount": 6474, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6261.72, "estimated_amount": 6261, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6261.72, "estimated_amount": 6261, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 6351.6, "estimated_amount": 6351, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 8633.24, "estimated_amount": 8633, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 6043.27, "estimated_amount": 6043, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 13286, "standard_charge_percentage": 65.0000, "estimated_amount": 13286, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 5858.27, "estimated_amount": 5858, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 4476.36, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 4476, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 11788.9, "estimated_amount": 11788, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 6474.93, "estimated_amount": 6474, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 4476.36, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 4476, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 16352, "standard_charge_percentage": 80.0000, "estimated_amount": 16352, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 6474.93, "estimated_amount": 6474, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 9989.89, "estimated_amount": 9989, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 6474.93, "estimated_amount": 6474, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 9558.23, "estimated_amount": 9558, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6574.81, "estimated_amount": 6574, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11199.4, "estimated_amount": 11199, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5334.84, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5334, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6261.72, "estimated_amount": 6261, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 6949.6, "standard_charge_percentage": 34.0000, "estimated_amount": 6949, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3647, "estimated_amount": 3647, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 14512.4, "standard_charge_percentage": 71.0000, "estimated_amount": 14512, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6261.72, "estimated_amount": 6261, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 6351.6, "estimated_amount": 6351, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 9249.9, "estimated_amount": 9249, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6261.72, "estimated_amount": 6261, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 15330, "standard_charge_percentage": 75.0000, "estimated_amount": 15330, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 16352, "standard_charge_percentage": 80.0000, "estimated_amount": 16352, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 16352, "standard_charge_percentage": 80.0000, "estimated_amount": 16352, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 5621, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 5621, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 10963.6, "estimated_amount": 10963, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6574.81, "estimated_amount": 6574, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 16352, "standard_charge_percentage": 80.0000, "estimated_amount": 16352, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 4476.36, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 4476, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 16965.2, "standard_charge_percentage": 83.0000, "estimated_amount": 16965, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 4088, "standard_charge_percentage": 20.0000, "estimated_amount": 4088, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6261.72, "estimated_amount": 6261, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 7091.59, "estimated_amount": 7091, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 14308, "standard_charge_percentage": 70.0000, "estimated_amount": 14308, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 6540.8, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 6540, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6132, "standard_charge_percentage": 30.0000, "estimated_amount": 6132, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 14064.8, "estimated_amount": 14064, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 839.33, "estimated_amount": 839, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 6351.6, "estimated_amount": 6351, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 8324.91, "estimated_amount": 8324, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 6783.26, "estimated_amount": 6783, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 9558.23, "estimated_amount": 9558, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 6166.6, "estimated_amount": 6166, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 7708.25, "estimated_amount": 7708, "methodology": "fee schedule" }]}]} , { "description": "RESET DISLOCATED JAW", "code_information": [ { "code": "21480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1829, "discounted_cash": 325,"minimum": 142.19,"maximum": 1518.07,"payers_information":[{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 223.38, "estimated_amount": 223, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 337.57, "estimated_amount": 337, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 212.74, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 477.37, "standard_charge_percentage": 26.1000, "estimated_amount": 477, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 350.07, "estimated_amount": 350, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 621.86, "standard_charge_percentage": 34.0000, "estimated_amount": 621, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 300.06, "estimated_amount": 300, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1371.75, "standard_charge_percentage": 75.0000, "estimated_amount": 1371, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1463.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1463, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1188.85, "standard_charge_percentage": 65.0000, "estimated_amount": 1188, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 237.55, "estimated_amount": 237, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1463.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1463, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 212.74, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 400.55, "standard_charge_percentage": 21.9000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1463.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1463, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 400.55, "standard_charge_percentage": 21.9000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 142.19, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 718.88, "estimated_amount": 718, "methodology": "case rate" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 223.38, "estimated_amount": 223, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1280.3, "standard_charge_percentage": 70.0000, "estimated_amount": 1280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 1518.07, "standard_charge_percentage": 83.0000, "estimated_amount": 1518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 142.19, "estimated_amount": 142, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1463.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1463, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 365.8, "standard_charge_percentage": 20.0000, "estimated_amount": 365, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1442, "estimated_amount": 1442, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 756.72, "estimated_amount": 756, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 703.75, "estimated_amount": 703, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 275.06, "estimated_amount": 275, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1463.2, "standard_charge_percentage": 80.0000, "estimated_amount": 1463, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 212.74, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 212.74, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 375.07, "estimated_amount": 375, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 400.55, "standard_charge_percentage": 21.9000, "estimated_amount": 400, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 502.98, "standard_charge_percentage": 27.5000, "estimated_amount": 502, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 548.7, "standard_charge_percentage": 30.0000, "estimated_amount": 548, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 312.56, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 405.08, "estimated_amount": 405, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 212.74, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 245.05, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 212.74, "estimated_amount": 212, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 287.56, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1499.78, "standard_charge_percentage": 82.0000, "estimated_amount": 1499, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 570.31, "estimated_amount": 570, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1298.59, "standard_charge_percentage": 71.0000, "estimated_amount": 1298, "methodology": "percent of total billed charges" }]}]} , { "description": "BIOPSY OF NECKCHEST", "code_information": [ { "code": "21550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3271, "discounted_cash": 2195,"minimum": 271.3,"maximum": 3271,"payers_information":[{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2101.11, "estimated_amount": 2101, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 3053, "estimated_amount": 3053, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 271.3, "estimated_amount": 271, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1112.14, "standard_charge_percentage": 34.0000, "estimated_amount": 1112, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3271, "estimated_amount": 3271, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 2616.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2616, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 2616.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2616, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 3053, "estimated_amount": 3053, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1046.72, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 1046, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2322.41, "standard_charge_percentage": 71.0000, "estimated_amount": 2322, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 899.52, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 853.73, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 853, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 654.2, "standard_charge_percentage": 20.0000, "estimated_amount": 654, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 716.35, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 716, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1954.03, "estimated_amount": 1954, "methodology": "case rate" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 2714.93, "standard_charge_percentage": 83.0000, "estimated_amount": 2714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 981.3, "standard_charge_percentage": 30.0000, "estimated_amount": 981, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2616.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2616, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 2453.25, "standard_charge_percentage": 75.0000, "estimated_amount": 2453, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 716.35, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 716, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2289.7, "standard_charge_percentage": 70.0000, "estimated_amount": 2289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 2616.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2616, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 716.35, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 716, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1996.05, "estimated_amount": 1996, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2126.15, "standard_charge_percentage": 65.0000, "estimated_amount": 2126, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3271, "estimated_amount": 3271, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2616.8, "standard_charge_percentage": 80.0000, "estimated_amount": 2616, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 271.3, "estimated_amount": 271, "methodology": "fee schedule" }]}]} , { "description": "EXC NECK LES SC 3 CM>", "code_information": [ { "code": "21552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13104, "discounted_cash": 3878,"minimum": 496.93,"maximum": 10876.3,"payers_information":[{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3931.2, "standard_charge_percentage": 30.0000, "estimated_amount": 3931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4193.28, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 4193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9828, "standard_charge_percentage": 75.0000, "estimated_amount": 9828, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3603.6, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3420.14, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3420, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 496.93, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 3053, "estimated_amount": 3053, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8517.6, "standard_charge_percentage": 65.0000, "estimated_amount": 8517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10876.3, "standard_charge_percentage": 83.0000, "estimated_amount": 10876, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6971.33, "standard_charge_percentage": 53.2000, "estimated_amount": 6971, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 3053, "estimated_amount": 3053, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2620.8, "standard_charge_percentage": 20.0000, "estimated_amount": 2620, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4455.36, "standard_charge_percentage": 34.0000, "estimated_amount": 4455, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9172.8, "standard_charge_percentage": 70.0000, "estimated_amount": 9172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1467, "estimated_amount": 1467, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 496.93, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 6483.34, "standard_charge_percentage": 53.2000, "estimated_amount": 6483, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6622.76, "standard_charge_percentage": 53.2000, "estimated_amount": 6622, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9303.84, "standard_charge_percentage": 71.0000, "estimated_amount": 9303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" }]}]} , { "description": "EXC NECK LES SC < 3 CM", "code_information": [ { "code": "21555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12573, "discounted_cash": 2195,"minimum": 456.51,"maximum": 10435.6,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2514.6, "standard_charge_percentage": 20.0000, "estimated_amount": 2514, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 456.51, "estimated_amount": 456, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4274.82, "standard_charge_percentage": 34.0000, "estimated_amount": 4274, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10058.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10058.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3457.57, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3457, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 8801.1, "standard_charge_percentage": 70.0000, "estimated_amount": 8801, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10058.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10058, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3281.55, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10058.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 3053, "estimated_amount": 3053, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2753.49, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2753, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9429.75, "standard_charge_percentage": 75.0000, "estimated_amount": 9429, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8172.45, "standard_charge_percentage": 65.0000, "estimated_amount": 8172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10435.6, "standard_charge_percentage": 83.0000, "estimated_amount": 10435, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2753.49, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2753, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 456.51, "estimated_amount": 456, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10058.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10058, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6192.56, "estimated_amount": 6192, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 3053, "estimated_amount": 3053, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 8926.83, "standard_charge_percentage": 71.0000, "estimated_amount": 8926, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2753.49, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2753, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5759.08, "estimated_amount": 5759, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3771.9, "standard_charge_percentage": 30.0000, "estimated_amount": 3771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5882.93, "estimated_amount": 5882, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "21556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5865, "discounted_cash": 3878,"minimum": 488,"maximum": 5865,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4692, "standard_charge_percentage": 80.0000, "estimated_amount": 4692, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4398.75, "standard_charge_percentage": 75.0000, "estimated_amount": 4398, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4692, "standard_charge_percentage": 80.0000, "estimated_amount": 4692, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1612.88, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1612, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4692, "standard_charge_percentage": 80.0000, "estimated_amount": 4692, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5759.08, "estimated_amount": 5759, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1284.43, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1284, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1284.43, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1284, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1759.5, "standard_charge_percentage": 30.0000, "estimated_amount": 1759, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4692, "standard_charge_percentage": 80.0000, "estimated_amount": 4692, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 577.1, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4105.5, "standard_charge_percentage": 70.0000, "estimated_amount": 4105, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1530.77, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5865, "estimated_amount": 5865, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1284.43, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1284, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1994.1, "standard_charge_percentage": 34.0000, "estimated_amount": 1994, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1173, "standard_charge_percentage": 20.0000, "estimated_amount": 1173, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 3053, "estimated_amount": 3053, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 5865, "estimated_amount": 5865, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 4867.95, "standard_charge_percentage": 83.0000, "estimated_amount": 4867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4164.15, "standard_charge_percentage": 71.0000, "estimated_amount": 4164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 5865, "estimated_amount": 5865, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 3053, "estimated_amount": 3053, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4692, "standard_charge_percentage": 80.0000, "estimated_amount": 4692, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3812.25, "standard_charge_percentage": 65.0000, "estimated_amount": 3812, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 577.1, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" }]}]} , { "description": "RESECT NECK TUM < 5 CM", "code_information": [ { "code": "21557", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17759, "discounted_cash": 3878,"minimum": 1045.52,"maximum": 14740,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 6038.06, "standard_charge_percentage": 34.0000, "estimated_amount": 6038, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5327.7, "standard_charge_percentage": 30.0000, "estimated_amount": 5327, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3889.22, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 14207.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 11543.4, "standard_charge_percentage": 65.0000, "estimated_amount": 11543, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 13319.3, "standard_charge_percentage": 75.0000, "estimated_amount": 13319, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4635.1, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3551.8, "standard_charge_percentage": 20.0000, "estimated_amount": 3551, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3889.22, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14207.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14207, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5759.08, "estimated_amount": 5759, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1045.52, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6192.56, "estimated_amount": 6192, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3889.22, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3889, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4883.73, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4883, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5882.93, "estimated_amount": 5882, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1045.52, "estimated_amount": 1045, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 14207.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 5682.88, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 5682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 14740, "standard_charge_percentage": 83.0000, "estimated_amount": 14739, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 3053, "estimated_amount": 3053, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 3053, "estimated_amount": 3053, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 12431.3, "standard_charge_percentage": 70.0000, "estimated_amount": 12431, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14207.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 14207.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 12608.9, "standard_charge_percentage": 71.0000, "estimated_amount": 12608, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2907.62, "estimated_amount": 2907, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 4439.75, "standard_charge_percentage": 25.0000, "estimated_amount": 4439, "methodology": "percent of total billed charges" }]}]} , { "description": "BIOPSY SOFT TISSUE OF BACK", "code_information": [ { "code": "21920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2420, "discounted_cash": 2195,"minimum": 262.66,"maximum": 2420,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1996.05, "estimated_amount": 1996, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1936, "standard_charge_percentage": 80.0000, "estimated_amount": 1936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 262.66, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 529.98, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 665.5, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 665, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1936, "standard_charge_percentage": 80.0000, "estimated_amount": 1936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 2420, "estimated_amount": 2420, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 631.62, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 631, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2420, "estimated_amount": 2420, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1936, "standard_charge_percentage": 80.0000, "estimated_amount": 1936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2420, "estimated_amount": 2420, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 726, "standard_charge_percentage": 30.0000, "estimated_amount": 726, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1718.2, "standard_charge_percentage": 71.0000, "estimated_amount": 1718, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 262.66, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 774.4, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 774, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1815, "standard_charge_percentage": 75.0000, "estimated_amount": 1815, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1694, "standard_charge_percentage": 70.0000, "estimated_amount": 1694, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 2008.6, "standard_charge_percentage": 83.0000, "estimated_amount": 2008, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 529.98, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 529.98, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1936, "standard_charge_percentage": 80.0000, "estimated_amount": 1936, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1954.03, "estimated_amount": 1954, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2420, "estimated_amount": 2420, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 484, "standard_charge_percentage": 20.0000, "estimated_amount": 484, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 2420, "estimated_amount": 2420, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1936, "standard_charge_percentage": 80.0000, "estimated_amount": 1936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1573, "standard_charge_percentage": 65.0000, "estimated_amount": 1573, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2101.11, "estimated_amount": 2101, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2420, "estimated_amount": 2420, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 822.8, "standard_charge_percentage": 34.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" }]}]} , { "description": "EXC BACK LES SC 3 CM>", "code_information": [ { "code": "21931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12101, "discounted_cash": 2195,"minimum": 524.73,"maximum": 10043.8,"payers_information":[{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2650.12, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2650, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9075.75, "standard_charge_percentage": 75.0000, "estimated_amount": 9075, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2420.2, "standard_charge_percentage": 20.0000, "estimated_amount": 2420, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3630.3, "standard_charge_percentage": 30.0000, "estimated_amount": 3630, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5987.09, "standard_charge_percentage": 53.2000, "estimated_amount": 5987, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 8470.7, "standard_charge_percentage": 70.0000, "estimated_amount": 8470, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10043.8, "standard_charge_percentage": 83.0000, "estimated_amount": 10043, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 9680.8, "standard_charge_percentage": 80.0000, "estimated_amount": 9680, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 9680.8, "standard_charge_percentage": 80.0000, "estimated_amount": 9680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3872.32, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 3872, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 524.73, "estimated_amount": 524, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7865.65, "standard_charge_percentage": 65.0000, "estimated_amount": 7865, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1467, "estimated_amount": 1467, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2650.12, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2650, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2650.12, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2650, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9680.8, "standard_charge_percentage": 80.0000, "estimated_amount": 9680, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3327.78, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3327, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9680.8, "standard_charge_percentage": 80.0000, "estimated_amount": 9680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6437.73, "standard_charge_percentage": 53.2000, "estimated_amount": 6437, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4114.34, "standard_charge_percentage": 34.0000, "estimated_amount": 4114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 9680.8, "standard_charge_percentage": 80.0000, "estimated_amount": 9680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6115.85, "standard_charge_percentage": 53.2000, "estimated_amount": 6115, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 8591.71, "standard_charge_percentage": 71.0000, "estimated_amount": 8591, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 524.73, "estimated_amount": 524, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3158.36, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3158, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" }]}]} , { "description": "EXC BACK TUM DEEP 5 CM>", "code_information": [ { "code": "21933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15111, "discounted_cash": 3878,"minimum": 820.15,"maximum": 12542.1,"payers_information":[{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5137.74, "standard_charge_percentage": 34.0000, "estimated_amount": 5137, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3943.97, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3943, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 10577.7, "standard_charge_percentage": 70.0000, "estimated_amount": 10577, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 7476.32, "standard_charge_percentage": 53.2000, "estimated_amount": 7476, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 820.15, "estimated_amount": 820, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4155.52, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 11333.3, "standard_charge_percentage": 75.0000, "estimated_amount": 11333, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 820.15, "estimated_amount": 820, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 12542.1, "standard_charge_percentage": 83.0000, "estimated_amount": 12542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4835.52, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 4835, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9822.15, "standard_charge_percentage": 65.0000, "estimated_amount": 9822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7637.1, "standard_charge_percentage": 53.2000, "estimated_amount": 7637, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 8039.05, "standard_charge_percentage": 53.2000, "estimated_amount": 8039, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1467, "estimated_amount": 1467, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 10728.8, "standard_charge_percentage": 71.0000, "estimated_amount": 10728, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4533.3, "standard_charge_percentage": 30.0000, "estimated_amount": 4533, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3022.2, "standard_charge_percentage": 20.0000, "estimated_amount": 3022, "methodology": "percent of total billed charges" }]}]} , { "description": "PERQ VERTEBRAL AUGMENTATION", "code_information": [ { "code": "22513", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13179, "discounted_cash": 9680,"minimum": 232,"maximum": 13179,"payers_information":[{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6196.79, "estimated_amount": 6196, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 13179, "estimated_amount": 13179, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3624.22, "standard_charge_percentage": 27.5000, "estimated_amount": 3624, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10543.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10543, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8566.35, "standard_charge_percentage": 65.0000, "estimated_amount": 8566, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 7011.23, "standard_charge_percentage": 53.2000, "estimated_amount": 7011, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10543.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10543, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3953.7, "standard_charge_percentage": 30.0000, "estimated_amount": 3953, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 3294.75, "standard_charge_percentage": 25.0000, "estimated_amount": 3294, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6196.79, "estimated_amount": 6196, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2635.8, "standard_charge_percentage": 20.0000, "estimated_amount": 2635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10543.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10543, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6506.63, "estimated_amount": 6506, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2886.2, "standard_charge_percentage": 21.9000, "estimated_amount": 2886, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6196.79, "estimated_amount": 6196, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9884.25, "standard_charge_percentage": 75.0000, "estimated_amount": 9884, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3439.72, "standard_charge_percentage": 26.1000, "estimated_amount": 3439, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 6520.44, "standard_charge_percentage": 53.2000, "estimated_amount": 6520, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 10806.8, "standard_charge_percentage": 82.0000, "estimated_amount": 10806, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9225.3, "standard_charge_percentage": 70.0000, "estimated_amount": 9225, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 232, "estimated_amount": 232, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6196.79, "estimated_amount": 6196, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 5372.62, "estimated_amount": 5372, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9357.09, "standard_charge_percentage": 71.0000, "estimated_amount": 9357, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10938.6, "standard_charge_percentage": 83.0000, "estimated_amount": 10938, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 5372.62, "estimated_amount": 5372, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4480.86, "standard_charge_percentage": 34.0000, "estimated_amount": 4480, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10543.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10543, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6196.79, "estimated_amount": 6196, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10543.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10543, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2886.2, "standard_charge_percentage": 21.9000, "estimated_amount": 2886, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6506.63, "estimated_amount": 6506, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2886.2, "standard_charge_percentage": 21.9000, "estimated_amount": 2886, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6660.67, "standard_charge_percentage": 53.2000, "estimated_amount": 6660, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6196.79, "estimated_amount": 6196, "methodology": "fee schedule" }]}]} , { "description": "EXC ABD LES SC < 3 CM", "code_information": [ { "code": "22902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2689.5, "discounted_cash": 2195,"minimum": 501.74,"maximum": 2689.5,"payers_information":[{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 501.74, "estimated_amount": 501, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1430.81, "standard_charge_percentage": 53.2000, "estimated_amount": 1430, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 589, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 589, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 914.43, "standard_charge_percentage": 34.0000, "estimated_amount": 914, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 2151.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1882.65, "standard_charge_percentage": 70.0000, "estimated_amount": 1882, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 537.9, "standard_charge_percentage": 20.0000, "estimated_amount": 537, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2151.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 2689.5, "estimated_amount": 2689, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 701.96, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 701, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 589, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 589, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1330.66, "standard_charge_percentage": 53.2000, "estimated_amount": 1330, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 2232.28, "standard_charge_percentage": 83.0000, "estimated_amount": 2232, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2689.5, "estimated_amount": 2689, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 589, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 589, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 739.61, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 739, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2151.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1748.17, "standard_charge_percentage": 65.0000, "estimated_amount": 1748, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 501.74, "estimated_amount": 501, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 860.64, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 860, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 2689.5, "estimated_amount": 2689, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 2151.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2151, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 2151.6, "standard_charge_percentage": 80.0000, "estimated_amount": 2151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1359.27, "standard_charge_percentage": 53.2000, "estimated_amount": 1359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1090, "estimated_amount": 1090, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 2017.13, "standard_charge_percentage": 75.0000, "estimated_amount": 2017, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1909.55, "standard_charge_percentage": 71.0000, "estimated_amount": 1909, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 806.85, "standard_charge_percentage": 30.0000, "estimated_amount": 806, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" }]}]} , { "description": "Exc abd les sc 3 cm/>", "code_information": [ { "code": "22903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11097, "discounted_cash": 3878,"minimum": 491.98,"maximum": 9210.51,"payers_information":[{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 5903.6, "standard_charge_percentage": 53.2000, "estimated_amount": 5903, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 491.98, "estimated_amount": 491, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3329.1, "standard_charge_percentage": 30.0000, "estimated_amount": 3329, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3551.04, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 3551, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 8322.75, "standard_charge_percentage": 75.0000, "estimated_amount": 8322, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 491.98, "estimated_amount": 491, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3051.68, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3051, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7213.05, "standard_charge_percentage": 65.0000, "estimated_amount": 7213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 9210.51, "standard_charge_percentage": 83.0000, "estimated_amount": 9210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5608.42, "standard_charge_percentage": 53.2000, "estimated_amount": 5608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1467, "estimated_amount": 1467, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7767.9, "standard_charge_percentage": 70.0000, "estimated_amount": 7767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7878.87, "standard_charge_percentage": 71.0000, "estimated_amount": 7878, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3772.98, "standard_charge_percentage": 34.0000, "estimated_amount": 3772, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5490.35, "standard_charge_percentage": 53.2000, "estimated_amount": 5490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2219.4, "standard_charge_percentage": 20.0000, "estimated_amount": 2219, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2896.32, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2896, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "23020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3892, "discounted_cash": 4396,"minimum": 488,"maximum": 3892,"payers_information":[{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3113.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3113, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2763.32, "standard_charge_percentage": 71.0000, "estimated_amount": 2763, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3113.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3113, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3113.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3113, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1070.3, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1070, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1015.81, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1015, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 852.35, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 852, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 758.16, "estimated_amount": 758, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 852.35, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 852, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3113.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3113, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1167.6, "standard_charge_percentage": 30.0000, "estimated_amount": 1167, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 2919, "standard_charge_percentage": 75.0000, "estimated_amount": 2919, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3113.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3113, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3230.36, "standard_charge_percentage": 83.0000, "estimated_amount": 3230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 758.16, "estimated_amount": 758, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1323.28, "standard_charge_percentage": 34.0000, "estimated_amount": 1323, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2529.8, "standard_charge_percentage": 65.0000, "estimated_amount": 2529, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2724.4, "standard_charge_percentage": 70.0000, "estimated_amount": 2724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 852.35, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 852, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 778.4, "standard_charge_percentage": 20.0000, "estimated_amount": 778, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "23071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10122, "discounted_cash": 2195,"minimum": 467.24,"maximum": 8401.26,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 8401.26, "standard_charge_percentage": 83.0000, "estimated_amount": 8401, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2783.55, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2783, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8097.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8097, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8097.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8097, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3036.6, "standard_charge_percentage": 30.0000, "estimated_amount": 3036, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1467, "estimated_amount": 1467, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 467.24, "estimated_amount": 467, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8097.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8097, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 5384.9, "standard_charge_percentage": 53.2000, "estimated_amount": 5384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8097.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8097, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7085.4, "standard_charge_percentage": 70.0000, "estimated_amount": 7085, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3239.04, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 3239, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8097.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8097, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 467.24, "estimated_amount": 467, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5007.96, "standard_charge_percentage": 53.2000, "estimated_amount": 5007, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 7591.5, "standard_charge_percentage": 75.0000, "estimated_amount": 7591, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2216.72, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2216, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2024.4, "standard_charge_percentage": 20.0000, "estimated_amount": 2024, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2216.72, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2216, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2641.84, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2641, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3441.48, "standard_charge_percentage": 34.0000, "estimated_amount": 3441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 6579.3, "standard_charge_percentage": 65.0000, "estimated_amount": 6579, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5115.66, "standard_charge_percentage": 53.2000, "estimated_amount": 5115, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7186.62, "standard_charge_percentage": 71.0000, "estimated_amount": 7186, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2216.72, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2216, "methodology": "percent of total billed charges" }]}]} , { "description": "EXC SHOULDER TUM DEEP < 5 CM", "code_information": [ { "code": "23076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11097, "discounted_cash": 3878,"minimum": 488,"maximum": 9210.51,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 601.26, "estimated_amount": 601, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5759.08, "estimated_amount": 5759, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7878.87, "standard_charge_percentage": 71.0000, "estimated_amount": 7878, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3051.68, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3051, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7767.9, "standard_charge_percentage": 70.0000, "estimated_amount": 7767, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5882.93, "estimated_amount": 5882, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 9210.51, "standard_charge_percentage": 83.0000, "estimated_amount": 9210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 601.26, "estimated_amount": 601, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2896.32, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2896, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7213.05, "standard_charge_percentage": 65.0000, "estimated_amount": 7213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3772.98, "standard_charge_percentage": 34.0000, "estimated_amount": 3772, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 8322.75, "standard_charge_percentage": 75.0000, "estimated_amount": 8322, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3329.1, "standard_charge_percentage": 30.0000, "estimated_amount": 3329, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2219.4, "standard_charge_percentage": 20.0000, "estimated_amount": 2219, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6192.56, "estimated_amount": 6192, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "23120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23876, "discounted_cash": 4396,"minimum": 643.09,"maximum": 19817.1,"payers_information":[{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6189.89, "estimated_amount": 6189, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 5228.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 5228, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 16713.2, "standard_charge_percentage": 70.0000, "estimated_amount": 16713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 19100.8, "standard_charge_percentage": 80.0000, "estimated_amount": 19100, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 5150, "estimated_amount": 5150, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 16952, "standard_charge_percentage": 71.0000, "estimated_amount": 16951, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 11793.1, "estimated_amount": 11793, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 6565.9, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 6565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 12046.8, "estimated_amount": 12046, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 8117.84, "standard_charge_percentage": 34.0000, "estimated_amount": 8117, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 19100.8, "standard_charge_percentage": 80.0000, "estimated_amount": 19100, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 12680.8, "estimated_amount": 12680, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 17907, "standard_charge_percentage": 75.0000, "estimated_amount": 17907, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 785, "estimated_amount": 785, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 643.09, "estimated_amount": 643, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 19100.8, "standard_charge_percentage": 80.0000, "estimated_amount": 19100, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 5228.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 5228, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 5228.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 5228, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7162.8, "standard_charge_percentage": 30.0000, "estimated_amount": 7162, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 15519.4, "standard_charge_percentage": 65.0000, "estimated_amount": 15519, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 643.09, "estimated_amount": 643, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6189.89, "estimated_amount": 6189, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 19100.8, "standard_charge_percentage": 80.0000, "estimated_amount": 19100, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 4775.2, "standard_charge_percentage": 20.0000, "estimated_amount": 4775, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 19817.1, "standard_charge_percentage": 83.0000, "estimated_amount": 19817, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 19100.8, "standard_charge_percentage": 80.0000, "estimated_amount": 19100, "methodology": "percent of total billed charges" }]}]} , { "description": "REMOVAL OF BONE LESION", "code_information": [ { "code": "23140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20902, "discounted_cash": 4396,"minimum": 611.13,"maximum": 17348.7,"payers_information":[{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5990.14, "estimated_amount": 5990, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 13586.3, "standard_charge_percentage": 65.0000, "estimated_amount": 13586, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 14631.4, "standard_charge_percentage": 70.0000, "estimated_amount": 14631, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 16721.6, "standard_charge_percentage": 80.0000, "estimated_amount": 16721, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6189.89, "estimated_amount": 6189, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6270.6, "standard_charge_percentage": 30.0000, "estimated_amount": 6270, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 7106.68, "standard_charge_percentage": 34.0000, "estimated_amount": 7106, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 16721.6, "standard_charge_percentage": 80.0000, "estimated_amount": 16721, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 4577.54, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 4577, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 16721.6, "standard_charge_percentage": 80.0000, "estimated_amount": 16721, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5455.42, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6118.96, "estimated_amount": 6118, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 14840.4, "standard_charge_percentage": 71.0000, "estimated_amount": 14840, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 4180.4, "standard_charge_percentage": 20.0000, "estimated_amount": 4180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 16721.6, "standard_charge_percentage": 80.0000, "estimated_amount": 16721, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 4577.54, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 4577, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 4577.54, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 4577, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 5748.05, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 5748, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 15676.5, "standard_charge_percentage": 75.0000, "estimated_amount": 15676, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 611.13, "estimated_amount": 611, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6189.89, "estimated_amount": 6189, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 16721.6, "standard_charge_percentage": 80.0000, "estimated_amount": 16721, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 17348.7, "standard_charge_percentage": 83.0000, "estimated_amount": 17348, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6441.01, "estimated_amount": 6441, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 611.13, "estimated_amount": 611, "methodology": "fee schedule" }]}]} , { "description": "INCISION OF TENDON & MUSCLE", "code_information": [ { "code": "23405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3892, "discounted_cash": 9680,"minimum": 488,"maximum": 3892,"payers_information":[{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 852.35, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 852, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3113.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3113, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 667.25, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3230.36, "standard_charge_percentage": 83.0000, "estimated_amount": 3230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1167.6, "standard_charge_percentage": 30.0000, "estimated_amount": 1167, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2529.8, "standard_charge_percentage": 65.0000, "estimated_amount": 2529, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3113.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3113, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 667.25, "estimated_amount": 667, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1015.81, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1015, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 778.4, "standard_charge_percentage": 20.0000, "estimated_amount": 778, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 852.35, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 852, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 2919, "standard_charge_percentage": 75.0000, "estimated_amount": 2919, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3113.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3113, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1323.28, "standard_charge_percentage": 34.0000, "estimated_amount": 1323, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 852.35, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 852, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2763.32, "standard_charge_percentage": 71.0000, "estimated_amount": 2763, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3113.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3113, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3113.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3113, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3892, "estimated_amount": 3892, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1070.3, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1070, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2724.4, "standard_charge_percentage": 70.0000, "estimated_amount": 2724, "methodology": "percent of total billed charges" }]}]} , { "description": "REPAIR ROTATOR CUFF ACUTE", "code_information": [ { "code": "23410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23352, "discounted_cash": 9680,"minimum": 785,"maximum": 19382.2,"payers_information":[{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 5114.09, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $9798", "estimated_amount": 5114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 12680.8, "estimated_amount": 12680, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 896.1, "estimated_amount": 896, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 4670.4, "standard_charge_percentage": 20.0000, "estimated_amount": 4670, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6189.89, "estimated_amount": 6189, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 896.1, "estimated_amount": 896, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 15178.8, "standard_charge_percentage": 65.0000, "estimated_amount": 15178, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 19382.2, "standard_charge_percentage": 83.0000, "estimated_amount": 19382, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 16346.4, "standard_charge_percentage": 70.0000, "estimated_amount": 16346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 7939.68, "standard_charge_percentage": 34.0000, "estimated_amount": 7939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6189.89, "estimated_amount": 6189, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 5150, "estimated_amount": 5150, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7005.6, "standard_charge_percentage": 30.0000, "estimated_amount": 7005, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 16579.9, "standard_charge_percentage": 71.0000, "estimated_amount": 16579, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 5114.09, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $9611", "estimated_amount": 5114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 785, "estimated_amount": 785, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 17514, "standard_charge_percentage": 75.0000, "estimated_amount": 17514, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 11793.1, "estimated_amount": 11793, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 6094.87, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $10419", "estimated_amount": 6094, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 12046.8, "estimated_amount": 12046, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 6421.8, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $13740", "estimated_amount": 6421, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 5114.09, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $9658", "estimated_amount": 5114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "23412", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18310.5, "discounted_cash": 9680,"minimum": 932.43,"maximum": 16984.6,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14648.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14648, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4779.04, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $10419", "estimated_amount": 4779, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6189.89, "estimated_amount": 6189, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 13000.5, "standard_charge_percentage": 71.0000, "estimated_amount": 13000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 12046.8, "estimated_amount": 12046, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 11793.1, "estimated_amount": 11793, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14648.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14648, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 15197.7, "standard_charge_percentage": 83.0000, "estimated_amount": 15197, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 14648.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14648, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 932.43, "estimated_amount": 932, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3662.1, "standard_charge_percentage": 20.0000, "estimated_amount": 3662, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 12680.8, "estimated_amount": 12680, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 14648.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14648, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5493.15, "standard_charge_percentage": 30.0000, "estimated_amount": 5493, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 14648.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14648, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 4010, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $9798", "estimated_amount": 4010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 6232, "estimated_amount": 6232, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 932.43, "estimated_amount": 932, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 4010, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $9611", "estimated_amount": 4010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6189.89, "estimated_amount": 6189, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 12817.4, "standard_charge_percentage": 70.0000, "estimated_amount": 12817, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 13732.9, "standard_charge_percentage": 75.0000, "estimated_amount": 13732, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3647, "estimated_amount": 3647, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 6225.57, "standard_charge_percentage": 34.0000, "estimated_amount": 6225, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 4010, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $9658", "estimated_amount": 4010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 11901.8, "standard_charge_percentage": 65.0000, "estimated_amount": 11901, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 5035.39, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $13740", "estimated_amount": 5035, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1090, "estimated_amount": 1090, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" }]}]} , { "description": "REPAIR OF SHOULDER", "code_information": [ { "code": "23420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21463.5, "discounted_cash": 9680,"minimum": 1067.93,"maximum": 17814.7,"payers_information":[{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 13951.3, "standard_charge_percentage": 65.0000, "estimated_amount": 13951, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 4700.51, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $9611", "estimated_amount": 4700, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1067.93, "estimated_amount": 1067, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6439.05, "standard_charge_percentage": 30.0000, "estimated_amount": 6439, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 16097.6, "standard_charge_percentage": 75.0000, "estimated_amount": 16097, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 17170.8, "standard_charge_percentage": 80.0000, "estimated_amount": 17170, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 17170.8, "standard_charge_percentage": 80.0000, "estimated_amount": 17170, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 5902.46, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $13740", "estimated_amount": 5902, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 15024.5, "standard_charge_percentage": 70.0000, "estimated_amount": 15024, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 7297.59, "standard_charge_percentage": 34.0000, "estimated_amount": 7297, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 17170.8, "standard_charge_percentage": 80.0000, "estimated_amount": 17170, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 17170.8, "standard_charge_percentage": 80.0000, "estimated_amount": 17170, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 11793.1, "estimated_amount": 11793, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 12046.8, "estimated_amount": 12046, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 6232, "estimated_amount": 6232, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6189.89, "estimated_amount": 6189, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 17170.8, "standard_charge_percentage": 80.0000, "estimated_amount": 17170, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 12680.8, "estimated_amount": 12680, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3647, "estimated_amount": 3647, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 15239.1, "standard_charge_percentage": 71.0000, "estimated_amount": 15239, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5601.97, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $10419", "estimated_amount": 5601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1090, "estimated_amount": 1090, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 4292.7, "standard_charge_percentage": 20.0000, "estimated_amount": 4292, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 17814.7, "standard_charge_percentage": 83.0000, "estimated_amount": 17814, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 4700.51, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $9798", "estimated_amount": 4700, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1067.93, "estimated_amount": 1067, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 4700.51, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $9658", "estimated_amount": 4700, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6189.89, "estimated_amount": 6189, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "23430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17959, "discounted_cash": 9680,"minimum": 690,"maximum": 16984.6,"payers_information":[{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 812.59, "estimated_amount": 812, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4938.73, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4938, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14367.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14367, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 11793.1, "estimated_amount": 11793, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 12046.8, "estimated_amount": 12046, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6189.89, "estimated_amount": 6189, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 14367.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14367, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4687.3, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4687, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 14906, "standard_charge_percentage": 83.0000, "estimated_amount": 14905, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14367.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14367, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3933.02, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6189.89, "estimated_amount": 6189, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3933.02, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5387.7, "standard_charge_percentage": 30.0000, "estimated_amount": 5387, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 14367.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14367, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 12571.3, "standard_charge_percentage": 70.0000, "estimated_amount": 12571, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3933.02, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 812.59, "estimated_amount": 812, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3591.8, "standard_charge_percentage": 20.0000, "estimated_amount": 3591, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 12750.9, "standard_charge_percentage": 71.0000, "estimated_amount": 12750, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 11673.4, "standard_charge_percentage": 65.0000, "estimated_amount": 11673, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 14367.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14367, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 12680.8, "estimated_amount": 12680, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 13469.3, "standard_charge_percentage": 75.0000, "estimated_amount": 13469, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 6106.06, "standard_charge_percentage": 34.0000, "estimated_amount": 6106, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" }]}]} , { "description": "RECONSTRUCT SHOULDER JOINT", "code_information": [ { "code": "23470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32280, "discounted_cash": 17436,"minimum": 1306.23,"maximum": 32280,"payers_information":[{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 20982, "standard_charge_percentage": 65.0000, "estimated_amount": 20982, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 22918.8, "standard_charge_percentage": 71.0000, "estimated_amount": 22918, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 16095.2, "estimated_amount": 16095, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 20118.9, "estimated_amount": 20118, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 25824, "standard_charge_percentage": 80.0000, "estimated_amount": 25824, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 16765.8, "estimated_amount": 16765, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 32280, "estimated_amount": 32280, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 25824, "standard_charge_percentage": 80.0000, "estimated_amount": 25824, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 30591.5, "estimated_amount": 30591, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 9528, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 9528, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 24210, "standard_charge_percentage": 75.0000, "estimated_amount": 24210, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 18777.7, "estimated_amount": 18777, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1306.23, "estimated_amount": 1306, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 13144.4, "estimated_amount": 13144, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 30766.1, "estimated_amount": 30766, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9684, "standard_charge_percentage": 30.0000, "estimated_amount": 9684, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 6456, "standard_charge_percentage": 20.0000, "estimated_amount": 6456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 15424.5, "estimated_amount": 15424, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 26792.4, "standard_charge_percentage": 83.0000, "estimated_amount": 26792, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 25824, "standard_charge_percentage": 80.0000, "estimated_amount": 25824, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 25824, "standard_charge_percentage": 80.0000, "estimated_amount": 25824, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 21728.5, "estimated_amount": 21728, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 8070, "standard_charge_percentage": 25.0000, "estimated_amount": 8070, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 14753.9, "estimated_amount": 14753, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 31427.7, "estimated_amount": 31427, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 22596, "standard_charge_percentage": 70.0000, "estimated_amount": 22596, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 12510.1, "estimated_amount": 12510, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 25824, "standard_charge_percentage": 80.0000, "estimated_amount": 25824, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 12510.1, "estimated_amount": 12510, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 12742, "estimated_amount": 12742, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1306.23, "estimated_amount": 1306, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8877, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 18107, "estimated_amount": 18107, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 10975.2, "standard_charge_percentage": 34.0000, "estimated_amount": 10975, "methodology": "percent of total billed charges" }]}]} , { "description": "RECONSTRUCT SHOULDER JOINT", "code_information": [ { "code": "23472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44967, "discounted_cash": 24921,"minimum": 1575.61,"maximum": 43723.3,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 18211.6, "estimated_amount": 18211, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 19170.2, "estimated_amount": 19170, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 19170.2, "estimated_amount": 19170, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 19170.2, "estimated_amount": 19170, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 35973.6, "standard_charge_percentage": 80.0000, "estimated_amount": 35973, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 28755.2, "estimated_amount": 28755, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 31476.9, "standard_charge_percentage": 70.0000, "estimated_amount": 31476, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 37322.6, "standard_charge_percentage": 83.0000, "estimated_amount": 37322, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 19170.2, "estimated_amount": 19170, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 19170.2, "estimated_amount": 19170, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 19170.2, "estimated_amount": 19170, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 29713.7, "estimated_amount": 29713, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 19170.2, "estimated_amount": 19170, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 19170.2, "estimated_amount": 19170, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 35973.6, "standard_charge_percentage": 80.0000, "estimated_amount": 35973, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 13490.1, "standard_charge_percentage": 30.0000, "estimated_amount": 13490, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 19170.2, "estimated_amount": 19170, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 19170.2, "estimated_amount": 19170, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 8993.4, "standard_charge_percentage": 20.0000, "estimated_amount": 8993, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 22726.3, "standard_charge_percentage": 53.2000, "estimated_amount": 22726, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8889, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 19170.2, "estimated_amount": 19170, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 35973.6, "standard_charge_percentage": 80.0000, "estimated_amount": 35973, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 20128.7, "estimated_amount": 20128, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 19745.3, "estimated_amount": 19745, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 20128.7, "estimated_amount": 20128, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 22045.7, "estimated_amount": 22045, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 23922.4, "standard_charge_percentage": 53.2000, "estimated_amount": 23922, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 25879.7, "estimated_amount": 25879, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 20128.7, "estimated_amount": 20128, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 31055.6, "estimated_amount": 31055, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 31926.6, "standard_charge_percentage": 71.0000, "estimated_amount": 31926, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 19170.2, "estimated_amount": 19170, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 19745.3, "estimated_amount": 19745, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 26838.2, "estimated_amount": 26838, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 35973.6, "standard_charge_percentage": 80.0000, "estimated_amount": 35973, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 19170.2, "estimated_amount": 19170, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 29228.5, "standard_charge_percentage": 65.0000, "estimated_amount": 29228, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 43723.3, "estimated_amount": 43723, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 33725.3, "standard_charge_percentage": 75.0000, "estimated_amount": 33725, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 19170.2, "estimated_amount": 19170, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 20128.7, "estimated_amount": 20128, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 18786.8, "estimated_amount": 18786, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 12510.1, "estimated_amount": 12510, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 19170.2, "estimated_amount": 19170, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 9528, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 9528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 15288.8, "standard_charge_percentage": 34.0000, "estimated_amount": 15288, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 19170.2, "estimated_amount": 19170, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 19745.3, "estimated_amount": 19745, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 23004.2, "estimated_amount": 23004, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 12510.1, "estimated_amount": 12510, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 22247.9, "standard_charge_percentage": 53.2000, "estimated_amount": 22247, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 23962.7, "estimated_amount": 23962, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 11241.8, "standard_charge_percentage": 25.0000, "estimated_amount": 11241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 19170.2, "estimated_amount": 19170, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 21087.2, "estimated_amount": 21087, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1575.61, "estimated_amount": 1575, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 35973.6, "standard_charge_percentage": 80.0000, "estimated_amount": 35973, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1575.61, "estimated_amount": 1575, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 29713.7, "estimated_amount": 29713, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 19170.2, "estimated_amount": 19170, "methodology": "fee schedule" }]}]} , { "description": "OPTX CLAVICULAR FX WINT FIX", "code_information": [ { "code": "23515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26619, "discounted_cash": 9680,"minimum": 558,"maximum": 22093.8,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 16422, "estimated_amount": 16422, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 18899.5, "standard_charge_percentage": 71.0000, "estimated_amount": 18899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16775.2, "estimated_amount": 16775, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 5829.56, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 5829, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 21295.2, "standard_charge_percentage": 80.0000, "estimated_amount": 21295, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 17658.1, "estimated_amount": 17658, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 788.09, "estimated_amount": 788, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 21295.2, "standard_charge_percentage": 80.0000, "estimated_amount": 21295, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 5829.56, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 5829, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 22093.8, "standard_charge_percentage": 83.0000, "estimated_amount": 22093, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 9050.46, "standard_charge_percentage": 34.0000, "estimated_amount": 9050, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 21295.2, "standard_charge_percentage": 80.0000, "estimated_amount": 21295, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7985.7, "standard_charge_percentage": 30.0000, "estimated_amount": 7985, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 18633.3, "standard_charge_percentage": 70.0000, "estimated_amount": 18633, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 5829.56, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 5829, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 788.09, "estimated_amount": 788, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 19964.3, "standard_charge_percentage": 75.0000, "estimated_amount": 19964, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 17302.3, "standard_charge_percentage": 65.0000, "estimated_amount": 17302, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 21295.2, "standard_charge_percentage": 80.0000, "estimated_amount": 21295, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 21295.2, "standard_charge_percentage": 80.0000, "estimated_amount": 21295, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 5323.8, "standard_charge_percentage": 20.0000, "estimated_amount": 5323, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 7320.23, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 7320, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" }]}]} , { "description": "OPTX ACROMCLV DISLC AQTCHRN", "code_information": [ { "code": "23550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19144, "discounted_cash": 9680,"minimum": 558,"maximum": 16984.6,"payers_information":[{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 4192.54, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 4192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 15315.2, "standard_charge_percentage": 80.0000, "estimated_amount": 15315, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 13592.2, "standard_charge_percentage": 71.0000, "estimated_amount": 13592, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3828.8, "standard_charge_percentage": 20.0000, "estimated_amount": 3828, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 625.44, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 15889.5, "standard_charge_percentage": 83.0000, "estimated_amount": 15889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 14358, "standard_charge_percentage": 75.0000, "estimated_amount": 14358, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 12443.6, "standard_charge_percentage": 65.0000, "estimated_amount": 12443, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 15315.2, "standard_charge_percentage": 80.0000, "estimated_amount": 15315, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15315.2, "standard_charge_percentage": 80.0000, "estimated_amount": 15315, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 15315.2, "standard_charge_percentage": 80.0000, "estimated_amount": 15315, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15315.2, "standard_charge_percentage": 80.0000, "estimated_amount": 15315, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 4192.54, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 4192, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 5264.6, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 5264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5743.2, "standard_charge_percentage": 30.0000, "estimated_amount": 5743, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 6508.96, "standard_charge_percentage": 34.0000, "estimated_amount": 6508, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 11584.9, "estimated_amount": 11584, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11005.7, "estimated_amount": 11005, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4996.58, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4996, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 10774, "estimated_amount": 10773, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 625.44, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 13400.8, "standard_charge_percentage": 70.0000, "estimated_amount": 13400, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 4192.54, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 4192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" }]}]} , { "description": "CLTX SCAP FX WMNPJ +-TRACTJ", "code_information": [ { "code": "23575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4366, "discounted_cash": 2168,"minimum": 365,"maximum": 3805.04,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3580.12, "standard_charge_percentage": 82.0000, "estimated_amount": 3580, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3056.2, "standard_charge_percentage": 70.0000, "estimated_amount": 3056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 453.68, "estimated_amount": 453, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3099.86, "standard_charge_percentage": 71.0000, "estimated_amount": 3099, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1484.44, "standard_charge_percentage": 34.0000, "estimated_amount": 1484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3274.5, "standard_charge_percentage": 75.0000, "estimated_amount": 3274, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 453.68, "estimated_amount": 453, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1200.65, "standard_charge_percentage": 27.5000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 873.2, "standard_charge_percentage": 20.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3623.78, "standard_charge_percentage": 83.0000, "estimated_amount": 3623, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1139.53, "standard_charge_percentage": 26.1000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2837.9, "standard_charge_percentage": 65.0000, "estimated_amount": 2837, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1442, "estimated_amount": 1442, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1309.8, "standard_charge_percentage": 30.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" }]}]} , { "description": "OPTX PROX HUMRL FX WINT FIX", "code_information": [ { "code": "23615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29312, "discounted_cash": 17436,"minimum": 690,"maximum": 29312,"payers_information":[{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 15424.5, "estimated_amount": 15424, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 966.27, "estimated_amount": 966, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 5862.4, "standard_charge_percentage": 20.0000, "estimated_amount": 5862, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 14753.9, "estimated_amount": 14753, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 20118.9, "estimated_amount": 20118, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 18777.7, "estimated_amount": 18777, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 21984, "standard_charge_percentage": 75.0000, "estimated_amount": 21984, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 13144.4, "estimated_amount": 13144, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 23449.6, "standard_charge_percentage": 80.0000, "estimated_amount": 23449, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 12742, "estimated_amount": 12742, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8060.8, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8060, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 29312, "estimated_amount": 29312, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 16095.2, "estimated_amount": 16095, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 24329, "standard_charge_percentage": 83.0000, "estimated_amount": 24328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 19052.8, "standard_charge_percentage": 65.0000, "estimated_amount": 19052, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16775.2, "estimated_amount": 16775, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 21728.5, "estimated_amount": 21728, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 18107, "estimated_amount": 18107, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 23449.6, "standard_charge_percentage": 80.0000, "estimated_amount": 23449, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 20811.5, "standard_charge_percentage": 71.0000, "estimated_amount": 20811, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 16765.8, "estimated_amount": 16765, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 16422, "estimated_amount": 16422, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 23449.6, "standard_charge_percentage": 80.0000, "estimated_amount": 23449, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 23449.6, "standard_charge_percentage": 80.0000, "estimated_amount": 23449, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 966.27, "estimated_amount": 966, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 23449.6, "standard_charge_percentage": 80.0000, "estimated_amount": 23449, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 9966.08, "standard_charge_percentage": 34.0000, "estimated_amount": 9966, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 17658.1, "estimated_amount": 17658, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8793.6, "standard_charge_percentage": 30.0000, "estimated_amount": 8793, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 20518.4, "standard_charge_percentage": 70.0000, "estimated_amount": 20518, "methodology": "percent of total billed charges" }]}]} , { "description": "CLTX SHO DSLC WMNPJ WO ANES", "code_information": [ { "code": "23650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 695, "discounted_cash": 325,"minimum": 139,"maximum": 695,"payers_information":[{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 375.07, "estimated_amount": 375, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 312.56, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 486.5, "standard_charge_percentage": 70.0000, "estimated_amount": 486, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 493.45, "standard_charge_percentage": 71.0000, "estimated_amount": 493, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 370.45, "estimated_amount": 370, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 208.5, "standard_charge_percentage": 30.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 521.25, "standard_charge_percentage": 75.0000, "estimated_amount": 521, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 569.9, "standard_charge_percentage": 82.0000, "estimated_amount": 569, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 236.3, "standard_charge_percentage": 34.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 695, "estimated_amount": 695, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 181.4, "standard_charge_percentage": 26.1000, "estimated_amount": 181, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 570.31, "estimated_amount": 570, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 576.85, "standard_charge_percentage": 83.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 287.56, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 300.06, "estimated_amount": 300, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 451.75, "standard_charge_percentage": 65.0000, "estimated_amount": 451, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 245.05, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 237.55, "estimated_amount": 237, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 191.13, "standard_charge_percentage": 27.5000, "estimated_amount": 191, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 337.57, "estimated_amount": 337, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 350.07, "estimated_amount": 350, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 139, "standard_charge_percentage": 20.0000, "estimated_amount": 139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 405.08, "estimated_amount": 405, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 275.06, "estimated_amount": 275, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 370.45, "estimated_amount": 370, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" }]}]} , { "description": "CLTX SHO DSLC WMNPJ WANES", "code_information": [ { "code": "23655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6320, "discounted_cash": 2168,"minimum": 365,"maximum": 5245.6,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4487.2, "standard_charge_percentage": 71.0000, "estimated_amount": 4487, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1738, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1738, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1896, "standard_charge_percentage": 30.0000, "estimated_amount": 1896, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5245.6, "standard_charge_percentage": 83.0000, "estimated_amount": 5245, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1272.63, "estimated_amount": 1272, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1384.08, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1384, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4424, "standard_charge_percentage": 70.0000, "estimated_amount": 4424, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1384.08, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5056, "standard_charge_percentage": 80.0000, "estimated_amount": 5056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4278.93, "estimated_amount": 4278, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1384.08, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1384, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1649.52, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1649, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5056, "standard_charge_percentage": 80.0000, "estimated_amount": 5056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 448.67, "estimated_amount": 448, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4504.14, "estimated_amount": 4504, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1272.63, "estimated_amount": 1272, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5056, "standard_charge_percentage": 80.0000, "estimated_amount": 5056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5056, "standard_charge_percentage": 80.0000, "estimated_amount": 5056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 448.67, "estimated_amount": 448, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5056, "standard_charge_percentage": 80.0000, "estimated_amount": 5056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4740, "standard_charge_percentage": 75.0000, "estimated_amount": 4740, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1442, "estimated_amount": 1442, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4108, "standard_charge_percentage": 65.0000, "estimated_amount": 4108, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2148.8, "standard_charge_percentage": 34.0000, "estimated_amount": 2148, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4188.85, "estimated_amount": 4188, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1264, "standard_charge_percentage": 20.0000, "estimated_amount": 1264, "methodology": "percent of total billed charges" }]}]} , { "description": "MNPJ ANES SHO JT FIXJ APRATS", "code_information": [ { "code": "23700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4072, "discounted_cash": 2168,"minimum": 213.97,"maximum": 4072,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4072, "estimated_amount": 4072, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2850.4, "standard_charge_percentage": 70.0000, "estimated_amount": 2850, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4072, "estimated_amount": 4072, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 213.97, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3257.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3257, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3054, "standard_charge_percentage": 75.0000, "estimated_amount": 3054, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1384.48, "standard_charge_percentage": 34.0000, "estimated_amount": 1384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3257.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3257, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2646.8, "standard_charge_percentage": 65.0000, "estimated_amount": 2646, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1221.6, "standard_charge_percentage": 30.0000, "estimated_amount": 1221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 213.97, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3257.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3257, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1119.8, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1119, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3379.76, "standard_charge_percentage": 83.0000, "estimated_amount": 3379, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3257.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3257, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 891.77, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 891, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1062.79, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1062, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 814.4, "standard_charge_percentage": 20.0000, "estimated_amount": 814, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 891.77, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2891.12, "standard_charge_percentage": 71.0000, "estimated_amount": 2891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 891.77, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1272.63, "estimated_amount": 1272, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4072, "estimated_amount": 4072, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1272.63, "estimated_amount": 1272, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3257.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3257, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4072, "estimated_amount": 4072, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1442, "estimated_amount": 1442, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" }]}]} , { "description": "Exc arm/elbow les sc 3 cm/>", "code_information": [ { "code": "24071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13595, "discounted_cash": 3878,"minimum": 449.88,"maximum": 11283.9,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8836.75, "standard_charge_percentage": 65.0000, "estimated_amount": 8836, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 449.88, "estimated_amount": 449, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1467, "estimated_amount": 1467, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2719, "standard_charge_percentage": 20.0000, "estimated_amount": 2719, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 10196.3, "standard_charge_percentage": 75.0000, "estimated_amount": 10196, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10876, "standard_charge_percentage": 80.0000, "estimated_amount": 10876, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 11283.9, "standard_charge_percentage": 83.0000, "estimated_amount": 11283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4350.4, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 4350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2977.3, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2977, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10876, "standard_charge_percentage": 80.0000, "estimated_amount": 10876, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3548.3, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3548, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4078.5, "standard_charge_percentage": 30.0000, "estimated_amount": 4078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3738.63, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3738, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 7232.54, "standard_charge_percentage": 53.2000, "estimated_amount": 7232, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4622.3, "standard_charge_percentage": 34.0000, "estimated_amount": 4622, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9516.5, "standard_charge_percentage": 70.0000, "estimated_amount": 9516, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10876, "standard_charge_percentage": 80.0000, "estimated_amount": 10876, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2977.3, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2977, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10876, "standard_charge_percentage": 80.0000, "estimated_amount": 10876, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9652.45, "standard_charge_percentage": 71.0000, "estimated_amount": 9652, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2977.3, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2977, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 6726.26, "standard_charge_percentage": 53.2000, "estimated_amount": 6726, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 449.88, "estimated_amount": 449, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6870.91, "standard_charge_percentage": 53.2000, "estimated_amount": 6870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10876, "standard_charge_percentage": 80.0000, "estimated_amount": 10876, "methodology": "percent of total billed charges" }]}]} , { "description": "EXC ARMELBOW LES SC < 3 CM", "code_information": [ { "code": "24075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10451, "discounted_cash": 2195,"minimum": 488,"maximum": 8674.33,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3135.3, "standard_charge_percentage": 30.0000, "estimated_amount": 3135, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8360.8, "standard_charge_percentage": 80.0000, "estimated_amount": 8360, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 551.94, "estimated_amount": 551, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2288.77, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2288, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 6793.15, "standard_charge_percentage": 65.0000, "estimated_amount": 6793, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4427.78, "estimated_amount": 4427, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4334.56, "estimated_amount": 4334, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3553.34, "standard_charge_percentage": 34.0000, "estimated_amount": 3553, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2090.2, "standard_charge_percentage": 20.0000, "estimated_amount": 2090, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2727.71, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2727, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8360.8, "standard_charge_percentage": 80.0000, "estimated_amount": 8360, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8360.8, "standard_charge_percentage": 80.0000, "estimated_amount": 8360, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8360.8, "standard_charge_percentage": 80.0000, "estimated_amount": 8360, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2288.77, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2288, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 8674.33, "standard_charge_percentage": 83.0000, "estimated_amount": 8674, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7420.21, "standard_charge_percentage": 71.0000, "estimated_amount": 7420, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2288.77, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2288, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4660.82, "estimated_amount": 4660, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 551.94, "estimated_amount": 551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7315.7, "standard_charge_percentage": 70.0000, "estimated_amount": 7315, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2874.03, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8360.8, "standard_charge_percentage": 80.0000, "estimated_amount": 8360, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 7838.25, "standard_charge_percentage": 75.0000, "estimated_amount": 7838, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" }]}]} , { "description": "Excision Olecranon Bursa", "code_information": [ { "code": "24105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28252, "discounted_cash": 4396,"minimum": 393.47,"maximum": 23449.2,"payers_information":[{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6118.96, "estimated_amount": 6118, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6187.19, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 22601.6, "standard_charge_percentage": 80.0000, "estimated_amount": 22601, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2240.27, "estimated_amount": 2240, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8475.6, "standard_charge_percentage": 30.0000, "estimated_amount": 8475, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 393.47, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 18363.8, "standard_charge_percentage": 65.0000, "estimated_amount": 18363, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 9605.68, "standard_charge_percentage": 34.0000, "estimated_amount": 9605, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 5650.4, "standard_charge_percentage": 20.0000, "estimated_amount": 5650, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6441.01, "estimated_amount": 6441, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6187.19, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 23449.2, "standard_charge_percentage": 83.0000, "estimated_amount": 23449, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 393.47, "estimated_amount": 393, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 7769.3, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 7769, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 19776.4, "standard_charge_percentage": 70.0000, "estimated_amount": 19776, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 21189, "standard_charge_percentage": 75.0000, "estimated_amount": 21189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 22601.6, "standard_charge_percentage": 80.0000, "estimated_amount": 22601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 22601.6, "standard_charge_percentage": 80.0000, "estimated_amount": 22601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 22601.6, "standard_charge_percentage": 80.0000, "estimated_amount": 22601, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6187.19, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2240.27, "estimated_amount": 2240, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5990.14, "estimated_amount": 5990, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 20058.9, "standard_charge_percentage": 71.0000, "estimated_amount": 20058, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 22601.6, "standard_charge_percentage": 80.0000, "estimated_amount": 22601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" }]}]} , { "description": "EXCCRTG B1 CSTB9 TUM RDS", "code_information": [ { "code": "24120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25151, "discounted_cash": 4396,"minimum": 558,"maximum": 20875.3,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2240.27, "estimated_amount": 2240, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 17857.2, "standard_charge_percentage": 71.0000, "estimated_amount": 17857, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7545.3, "standard_charge_percentage": 30.0000, "estimated_amount": 7545, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 20120.8, "standard_charge_percentage": 80.0000, "estimated_amount": 20120, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 20120.8, "standard_charge_percentage": 80.0000, "estimated_amount": 20120, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 5508.07, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 5508, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 18863.3, "standard_charge_percentage": 75.0000, "estimated_amount": 18863, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 20120.8, "standard_charge_percentage": 80.0000, "estimated_amount": 20120, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 5508.07, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 5508, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 6916.52, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 6916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6118.96, "estimated_amount": 6118, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6441.01, "estimated_amount": 6441, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 17605.7, "standard_charge_percentage": 70.0000, "estimated_amount": 17605, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 20120.8, "standard_charge_percentage": 80.0000, "estimated_amount": 20120, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 16348.2, "standard_charge_percentage": 65.0000, "estimated_amount": 16348, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 586.24, "estimated_amount": 586, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 5508.07, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 5508, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 5030.2, "standard_charge_percentage": 20.0000, "estimated_amount": 5030, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2240.27, "estimated_amount": 2240, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 586.24, "estimated_amount": 586, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 8551.34, "standard_charge_percentage": 34.0000, "estimated_amount": 8551, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5990.14, "estimated_amount": 5990, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20120.8, "standard_charge_percentage": 80.0000, "estimated_amount": 20120, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 20875.3, "standard_charge_percentage": 83.0000, "estimated_amount": 20875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" }]}]} , { "description": "REPAIR OF RUPTURED TENDON", "code_information": [ { "code": "24342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28225, "discounted_cash": 9680,"minimum": 558,"maximum": 23426.8,"payers_information":[{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 5645, "standard_charge_percentage": 20.0000, "estimated_amount": 5645, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 21168.8, "standard_charge_percentage": 75.0000, "estimated_amount": 21168, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6189.89, "estimated_amount": 6189, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 846.86, "estimated_amount": 846, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 22580, "standard_charge_percentage": 80.0000, "estimated_amount": 22580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6189.89, "estimated_amount": 6189, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 23426.8, "standard_charge_percentage": 83.0000, "estimated_amount": 23426, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6181.27, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 9596.5, "standard_charge_percentage": 34.0000, "estimated_amount": 9596, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6181.27, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6181, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 19757.5, "standard_charge_percentage": 70.0000, "estimated_amount": 19757, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 12046.8, "estimated_amount": 12046, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 22580, "standard_charge_percentage": 80.0000, "estimated_amount": 22580, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 22580, "standard_charge_percentage": 80.0000, "estimated_amount": 22580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 11793.1, "estimated_amount": 11793, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 846.86, "estimated_amount": 846, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 22580, "standard_charge_percentage": 80.0000, "estimated_amount": 22580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 22580, "standard_charge_percentage": 80.0000, "estimated_amount": 22580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 18346.3, "standard_charge_percentage": 65.0000, "estimated_amount": 18346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 12680.8, "estimated_amount": 12680, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8467.5, "standard_charge_percentage": 30.0000, "estimated_amount": 8467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6181.27, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 7761.88, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 7761, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 5895.13, "estimated_amount": 5895, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 20039.8, "standard_charge_percentage": 71.0000, "estimated_amount": 20039, "methodology": "percent of total billed charges" }]}]} , { "description": "Treat humerus fracture", "code_information": [ { "code": "24500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8528, "discounted_cash": 325,"minimum": 237.55,"maximum": 7078.24,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2558.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2558, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 287.56, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 405.08, "estimated_amount": 405, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1705.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2345.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2345, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6054.88, "standard_charge_percentage": 71.0000, "estimated_amount": 6054, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 350.07, "estimated_amount": 350, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 300.06, "estimated_amount": 300, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2899.52, "standard_charge_percentage": 34.0000, "estimated_amount": 2899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6396, "standard_charge_percentage": 75.0000, "estimated_amount": 6396, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 275.06, "estimated_amount": 275, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 399.68, "estimated_amount": 399, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5543.2, "standard_charge_percentage": 65.0000, "estimated_amount": 5543, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 399.68, "estimated_amount": 399, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1442, "estimated_amount": 1442, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 375.07, "estimated_amount": 375, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7078.24, "standard_charge_percentage": 83.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 312.56, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 237.55, "estimated_amount": 237, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 245.05, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 337.57, "estimated_amount": 337, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 570.31, "estimated_amount": 570, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5969.6, "standard_charge_percentage": 70.0000, "estimated_amount": 5969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2225.81, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2225, "methodology": "percent of total billed charges" }]}]} , { "description": "TREAT HUMERUS FRACTURE", "code_information": [ { "code": "24516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54413, "discounted_cash": 17436,"minimum": 690,"maximum": 45162.8,"payers_information":[{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 15424.5, "estimated_amount": 15424, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 10882.6, "standard_charge_percentage": 20.0000, "estimated_amount": 10882, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 20118.9, "estimated_amount": 20118, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 18107, "estimated_amount": 18107, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 940.18, "estimated_amount": 940, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 18500.4, "standard_charge_percentage": 34.0000, "estimated_amount": 18500, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 43530.4, "standard_charge_percentage": 80.0000, "estimated_amount": 43530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 13144.4, "estimated_amount": 13144, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 21728.5, "estimated_amount": 21728, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 38633.2, "standard_charge_percentage": 71.0000, "estimated_amount": 38633, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 16323.9, "standard_charge_percentage": 30.0000, "estimated_amount": 16323, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 43530.4, "standard_charge_percentage": 80.0000, "estimated_amount": 43530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 16422, "estimated_amount": 16422, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 40809.8, "standard_charge_percentage": 75.0000, "estimated_amount": 40809, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 16765.8, "estimated_amount": 16765, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 43530.4, "standard_charge_percentage": 80.0000, "estimated_amount": 43530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 17658.1, "estimated_amount": 17658, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 38089.1, "standard_charge_percentage": 70.0000, "estimated_amount": 38089, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16775.2, "estimated_amount": 16775, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 43530.4, "standard_charge_percentage": 80.0000, "estimated_amount": 43530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 940.18, "estimated_amount": 940, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 35368.4, "standard_charge_percentage": 65.0000, "estimated_amount": 35368, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 45162.8, "standard_charge_percentage": 83.0000, "estimated_amount": 45162, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 30591.5, "estimated_amount": 30591, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 16095.2, "estimated_amount": 16095, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 14753.9, "estimated_amount": 14753, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8889, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8889, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 12742, "estimated_amount": 12742, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 18777.7, "estimated_amount": 18777, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 43530.4, "standard_charge_percentage": 80.0000, "estimated_amount": 43530, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "24545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21112, "discounted_cash": 17436,"minimum": 690,"maximum": 21112,"payers_information":[{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 21112, "estimated_amount": 21112, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 16889.6, "standard_charge_percentage": 80.0000, "estimated_amount": 16889, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 12742, "estimated_amount": 12742, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 16889.6, "standard_charge_percentage": 80.0000, "estimated_amount": 16889, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 15834, "standard_charge_percentage": 75.0000, "estimated_amount": 15834, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16775.2, "estimated_amount": 16775, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 17523, "standard_charge_percentage": 83.0000, "estimated_amount": 17522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 20118.9, "estimated_amount": 20118, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1017.61, "estimated_amount": 1017, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 18107, "estimated_amount": 18107, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 4623.53, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 4623, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 13144.4, "estimated_amount": 13144, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 16889.6, "standard_charge_percentage": 80.0000, "estimated_amount": 16889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 16765.8, "estimated_amount": 16765, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 16889.6, "standard_charge_percentage": 80.0000, "estimated_amount": 16889, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 4623.53, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 4623, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1017.61, "estimated_amount": 1017, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5510.23, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5510, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 14989.5, "standard_charge_percentage": 71.0000, "estimated_amount": 14989, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 5805.8, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 5805, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 16889.6, "standard_charge_percentage": 80.0000, "estimated_amount": 16889, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 17658.1, "estimated_amount": 17658, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 15424.5, "estimated_amount": 15424, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 4222.4, "standard_charge_percentage": 20.0000, "estimated_amount": 4222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 13722.8, "standard_charge_percentage": 65.0000, "estimated_amount": 13722, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 14753.9, "estimated_amount": 14753, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 4623.53, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 4623, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 14778.4, "standard_charge_percentage": 70.0000, "estimated_amount": 14778, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 18777.7, "estimated_amount": 18777, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 7178.08, "standard_charge_percentage": 34.0000, "estimated_amount": 7178, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 16422, "estimated_amount": 16422, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 21112, "estimated_amount": 21112, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6333.6, "standard_charge_percentage": 30.0000, "estimated_amount": 6333, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 16095.2, "estimated_amount": 16095, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "24546", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16820, "discounted_cash": 17436,"minimum": 785,"maximum": 16820,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5718.8, "standard_charge_percentage": 34.0000, "estimated_amount": 5718, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3683.58, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3683, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 16820, "estimated_amount": 16820, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13456, "standard_charge_percentage": 80.0000, "estimated_amount": 13456, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 13456, "standard_charge_percentage": 80.0000, "estimated_amount": 13456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4390.02, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4390, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 13456, "standard_charge_percentage": 80.0000, "estimated_amount": 13456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3683.58, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 16422, "estimated_amount": 16422, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 13960.6, "standard_charge_percentage": 83.0000, "estimated_amount": 13960, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 16820, "estimated_amount": 16820, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 10933, "standard_charge_percentage": 65.0000, "estimated_amount": 10933, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 16095.2, "estimated_amount": 16095, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3364, "standard_charge_percentage": 20.0000, "estimated_amount": 3364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13456, "standard_charge_percentage": 80.0000, "estimated_amount": 13456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 16820, "estimated_amount": 16820, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3683.58, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16820, "estimated_amount": 16820, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1136.5, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 5150, "estimated_amount": 5150, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 13144.4, "estimated_amount": 13144, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16775.2, "estimated_amount": 16775, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 16820, "estimated_amount": 16820, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 15424.5, "estimated_amount": 15424, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 14753.9, "estimated_amount": 14753, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 13456, "standard_charge_percentage": 80.0000, "estimated_amount": 13456, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 12615, "standard_charge_percentage": 75.0000, "estimated_amount": 12615, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 11942.2, "standard_charge_percentage": 71.0000, "estimated_amount": 11942, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 16765.8, "estimated_amount": 16765, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5046, "standard_charge_percentage": 30.0000, "estimated_amount": 5046, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1136.5, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 16820, "estimated_amount": 16820, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 16820, "estimated_amount": 16820, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 16820, "estimated_amount": 16820, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 12742, "estimated_amount": 12742, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 11774, "standard_charge_percentage": 70.0000, "estimated_amount": 11774, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4625.5, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 785, "estimated_amount": 785, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" }]}]} , { "description": "TREAT HUMERUS FRACTURE", "code_information": [ { "code": "24579", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29312, "discounted_cash": 17436,"minimum": 558,"maximum": 29312,"payers_information":[{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 5862.4, "standard_charge_percentage": 20.0000, "estimated_amount": 5862, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 20518.4, "standard_charge_percentage": 70.0000, "estimated_amount": 20518, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 23449.6, "standard_charge_percentage": 80.0000, "estimated_amount": 23449, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 21984, "standard_charge_percentage": 75.0000, "estimated_amount": 21984, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 14753.9, "estimated_amount": 14753, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 18777.7, "estimated_amount": 18777, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 13144.4, "estimated_amount": 13144, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 23449.6, "standard_charge_percentage": 80.0000, "estimated_amount": 23449, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 16765.8, "estimated_amount": 16765, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 17658.1, "estimated_amount": 17658, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 20118.9, "estimated_amount": 20118, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 15424.5, "estimated_amount": 15424, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 19052.8, "standard_charge_percentage": 65.0000, "estimated_amount": 19052, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 18107, "estimated_amount": 18107, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 9966.08, "standard_charge_percentage": 34.0000, "estimated_amount": 9966, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 12742, "estimated_amount": 12742, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 21728.5, "estimated_amount": 21728, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 29312, "estimated_amount": 29312, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8060.8, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8060, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 23449.6, "standard_charge_percentage": 80.0000, "estimated_amount": 23449, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 23449.6, "standard_charge_percentage": 80.0000, "estimated_amount": 23449, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8793.6, "standard_charge_percentage": 30.0000, "estimated_amount": 8793, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 16095.2, "estimated_amount": 16095, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 16422, "estimated_amount": 16422, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 20811.5, "standard_charge_percentage": 71.0000, "estimated_amount": 20811, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 23449.6, "standard_charge_percentage": 80.0000, "estimated_amount": 23449, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16775.2, "estimated_amount": 16775, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 24329, "standard_charge_percentage": 83.0000, "estimated_amount": 24328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 914.6, "estimated_amount": 914, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 914.6, "estimated_amount": 914, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" }]}]} , { "description": "TREAT ELBOW FRACTURE", "code_information": [ { "code": "24586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45402, "discounted_cash": 17436,"minimum": 690,"maximum": 37683.7,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 20118.9, "estimated_amount": 20118, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 16095.2, "estimated_amount": 16095, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 18107, "estimated_amount": 18107, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 16422, "estimated_amount": 16422, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 34051.5, "standard_charge_percentage": 75.0000, "estimated_amount": 34051, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 16765.8, "estimated_amount": 16765, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 29511.3, "standard_charge_percentage": 65.0000, "estimated_amount": 29511, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 18777.7, "estimated_amount": 18777, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 32235.4, "standard_charge_percentage": 71.0000, "estimated_amount": 32235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1182.62, "estimated_amount": 1182, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 30591.5, "estimated_amount": 30591, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 17658.1, "estimated_amount": 17658, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 15436.7, "standard_charge_percentage": 34.0000, "estimated_amount": 15436, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8889, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 9080.4, "standard_charge_percentage": 20.0000, "estimated_amount": 9080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 36321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 36321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 21728.5, "estimated_amount": 21728, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 36321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 36321, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 36321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 36321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 36321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 36321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16775.2, "estimated_amount": 16775, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 14753.9, "estimated_amount": 14753, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1182.62, "estimated_amount": 1182, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 13144.4, "estimated_amount": 13144, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 36321.6, "standard_charge_percentage": 80.0000, "estimated_amount": 36321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 31781.4, "standard_charge_percentage": 70.0000, "estimated_amount": 31781, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 13620.6, "standard_charge_percentage": 30.0000, "estimated_amount": 13620, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 37683.7, "standard_charge_percentage": 83.0000, "estimated_amount": 37683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 15424.5, "estimated_amount": 15424, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 12742, "estimated_amount": 12742, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" }]}]} , { "description": "TREAT ELBOW DISLOCATION", "code_information": [ { "code": "24600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 695, "discounted_cash": 325,"minimum": 139,"maximum": 695,"payers_information":[{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 486.5, "standard_charge_percentage": 70.0000, "estimated_amount": 486, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 275.06, "estimated_amount": 275, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 405.08, "estimated_amount": 405, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 695, "estimated_amount": 695, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 569.9, "standard_charge_percentage": 82.0000, "estimated_amount": 569, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 337.57, "estimated_amount": 337, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 493.45, "standard_charge_percentage": 71.0000, "estimated_amount": 493, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 208.5, "standard_charge_percentage": 30.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 312.56, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 287.56, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 576.85, "standard_charge_percentage": 83.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 521.25, "standard_charge_percentage": 75.0000, "estimated_amount": 521, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 245.05, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 570.31, "estimated_amount": 570, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 451.75, "standard_charge_percentage": 65.0000, "estimated_amount": 451, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 420.16, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 300.06, "estimated_amount": 300, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 139, "standard_charge_percentage": 20.0000, "estimated_amount": 139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 191.13, "standard_charge_percentage": 27.5000, "estimated_amount": 191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 237.55, "estimated_amount": 237, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 181.4, "standard_charge_percentage": 26.1000, "estimated_amount": 181, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 350.07, "estimated_amount": 350, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 236.3, "standard_charge_percentage": 34.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 375.07, "estimated_amount": 375, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 420.16, "estimated_amount": 420, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Monteggia Fx/Disloc Elbow W Manip", "code_information": [ { "code": "24620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4366, "discounted_cash": 2168,"minimum": 483.81,"maximum": 3805.04,"payers_information":[{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1200.65, "standard_charge_percentage": 27.5000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 873.2, "standard_charge_percentage": 20.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3274.5, "standard_charge_percentage": 75.0000, "estimated_amount": 3274, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1309.8, "standard_charge_percentage": 30.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 647.81, "estimated_amount": 647, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3056.2, "standard_charge_percentage": 70.0000, "estimated_amount": 3056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 647.81, "estimated_amount": 647, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3099.86, "standard_charge_percentage": 71.0000, "estimated_amount": 3099, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2837.9, "standard_charge_percentage": 65.0000, "estimated_amount": 2837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3623.78, "standard_charge_percentage": 83.0000, "estimated_amount": 3623, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1484.44, "standard_charge_percentage": 34.0000, "estimated_amount": 1484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3580.12, "standard_charge_percentage": 82.0000, "estimated_amount": 3580, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1139.53, "standard_charge_percentage": 26.1000, "estimated_amount": 1139, "methodology": "percent of total billed charges" }]}]} , { "description": "TREAT ELBOW DISLOCATION", "code_information": [ { "code": "24640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 695, "discounted_cash": 325,"minimum": 105.5,"maximum": 606.49,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 275.06, "estimated_amount": 275, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 208.5, "standard_charge_percentage": 30.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 521.25, "standard_charge_percentage": 75.0000, "estimated_amount": 521, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 451.75, "standard_charge_percentage": 65.0000, "estimated_amount": 451, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 405.08, "estimated_amount": 405, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 287.56, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 245.05, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 237.55, "estimated_amount": 237, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 569.9, "standard_charge_percentage": 82.0000, "estimated_amount": 569, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 105.5, "estimated_amount": 105, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 300.06, "estimated_amount": 300, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 181.4, "standard_charge_percentage": 26.1000, "estimated_amount": 181, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 570.31, "estimated_amount": 570, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 350.07, "estimated_amount": 350, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 191.13, "standard_charge_percentage": 27.5000, "estimated_amount": 191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 139, "standard_charge_percentage": 20.0000, "estimated_amount": 139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 576.85, "standard_charge_percentage": 83.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 486.5, "standard_charge_percentage": 70.0000, "estimated_amount": 486, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 291.9, "standard_charge_percentage": 42.0000, "estimated_amount": 291, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 312.56, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 375.07, "estimated_amount": 375, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 337.57, "estimated_amount": 337, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 105.5, "estimated_amount": 105, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 493.45, "standard_charge_percentage": 71.0000, "estimated_amount": 493, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 236.3, "standard_charge_percentage": 34.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" }]}]} , { "description": "Treat Ulnar Fracture", "code_information": [ { "code": "24685", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30702, "discounted_cash": 9680,"minimum": 558,"maximum": 25482.7,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 24561.6, "standard_charge_percentage": 80.0000, "estimated_amount": 24561, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 10438.7, "standard_charge_percentage": 34.0000, "estimated_amount": 10438, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 24561.6, "standard_charge_percentage": 80.0000, "estimated_amount": 24561, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 715.22, "estimated_amount": 715, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 715.22, "estimated_amount": 715, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 23026.5, "standard_charge_percentage": 75.0000, "estimated_amount": 23026, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11005.7, "estimated_amount": 11005, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9210.6, "standard_charge_percentage": 30.0000, "estimated_amount": 9210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8443.05, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8443, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 19956.3, "standard_charge_percentage": 65.0000, "estimated_amount": 19956, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 24561.6, "standard_charge_percentage": 80.0000, "estimated_amount": 24561, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 10774, "estimated_amount": 10773, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 24561.6, "standard_charge_percentage": 80.0000, "estimated_amount": 24561, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 11584.9, "estimated_amount": 11584, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 21491.4, "standard_charge_percentage": 70.0000, "estimated_amount": 21491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 21798.4, "standard_charge_percentage": 71.0000, "estimated_amount": 21798, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 6140.4, "standard_charge_percentage": 20.0000, "estimated_amount": 6140, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 24561.6, "standard_charge_percentage": 80.0000, "estimated_amount": 24561, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 25482.7, "standard_charge_percentage": 83.0000, "estimated_amount": 25482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" }]}]} , { "description": "UNLISTED PX HUMERUSELBOW", "code_information": [ { "code": "24999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5652, "discounted_cash": 325,"minimum": 237.55,"maximum": 4691.16,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1237.79, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1237, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4239, "standard_charge_percentage": 75.0000, "estimated_amount": 4239, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1695.6, "standard_charge_percentage": 30.0000, "estimated_amount": 1695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 405.08, "estimated_amount": 405, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 287.56, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4521.6, "standard_charge_percentage": 80.0000, "estimated_amount": 4521, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1921.68, "standard_charge_percentage": 34.0000, "estimated_amount": 1921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3673.8, "standard_charge_percentage": 65.0000, "estimated_amount": 3673, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 350.07, "estimated_amount": 350, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 237.55, "estimated_amount": 237, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1554.3, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1554, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 275.06, "estimated_amount": 275, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4521.6, "standard_charge_percentage": 80.0000, "estimated_amount": 4521, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 300.06, "estimated_amount": 300, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 337.57, "estimated_amount": 337, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1808.64, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 1808, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4521.6, "standard_charge_percentage": 80.0000, "estimated_amount": 4521, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3956.4, "standard_charge_percentage": 70.0000, "estimated_amount": 3956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4521.6, "standard_charge_percentage": 80.0000, "estimated_amount": 4521, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1695.6, "standard_charge_percentage": 30.0000, "estimated_amount": 1695, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 4691.16, "standard_charge_percentage": 83.0000, "estimated_amount": 4691, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1237.79, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1237, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 375.07, "estimated_amount": 375, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1130.4, "standard_charge_percentage": 20.0000, "estimated_amount": 1130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4521.6, "standard_charge_percentage": 80.0000, "estimated_amount": 4521, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4012.92, "standard_charge_percentage": 71.0000, "estimated_amount": 4012, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1237.79, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1237, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1413, "standard_charge_percentage": 25.0000, "estimated_amount": 1413, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1475.17, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1475, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 570.31, "estimated_amount": 570, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 245.05, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 312.56, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" }]}]} , { "description": "INCISION OF TENDON SHEATH", "code_information": [ { "code": "25000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13104, "discounted_cash": 2168,"minimum": 376.45,"maximum": 10876.3,"payers_information":[{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3603.6, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2240.27, "estimated_amount": 2240, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 376.45, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9303.84, "standard_charge_percentage": 71.0000, "estimated_amount": 9303, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9828, "standard_charge_percentage": 75.0000, "estimated_amount": 9828, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5990.14, "estimated_amount": 5990, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2620.8, "standard_charge_percentage": 20.0000, "estimated_amount": 2620, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6118.96, "estimated_amount": 6118, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3931.2, "standard_charge_percentage": 30.0000, "estimated_amount": 3931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 376.45, "estimated_amount": 376, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4455.36, "standard_charge_percentage": 34.0000, "estimated_amount": 4455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10876.3, "standard_charge_percentage": 83.0000, "estimated_amount": 10876, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6441.01, "estimated_amount": 6441, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9172.8, "standard_charge_percentage": 70.0000, "estimated_amount": 9172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8517.6, "standard_charge_percentage": 65.0000, "estimated_amount": 8517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2240.27, "estimated_amount": 2240, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3420.14, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" }]}]} , { "description": "EXC FOREARM LES SC 3 CM>", "code_information": [ { "code": "25071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18372, "discounted_cash": 2195,"minimum": 468.65,"maximum": 15248.8,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 14697.6, "standard_charge_percentage": 80.0000, "estimated_amount": 14697, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 14697.6, "standard_charge_percentage": 80.0000, "estimated_amount": 14697, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 4023.47, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 4023, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 5879.04, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 5879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2240.27, "estimated_amount": 2240, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 9089.73, "standard_charge_percentage": 53.2000, "estimated_amount": 9089, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14697.6, "standard_charge_percentage": 80.0000, "estimated_amount": 14697, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2240.27, "estimated_amount": 2240, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1467, "estimated_amount": 1467, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 6246.48, "standard_charge_percentage": 34.0000, "estimated_amount": 6246, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 4023.47, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 4023, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5511.6, "standard_charge_percentage": 30.0000, "estimated_amount": 5511, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3674.4, "standard_charge_percentage": 20.0000, "estimated_amount": 3674, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 11941.8, "standard_charge_percentage": 65.0000, "estimated_amount": 11941, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 5052.3, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 5052, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 468.65, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 12860.4, "standard_charge_percentage": 70.0000, "estimated_amount": 12860, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 9773.9, "standard_charge_percentage": 53.2000, "estimated_amount": 9773, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 15248.8, "standard_charge_percentage": 83.0000, "estimated_amount": 15248, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 9285.21, "standard_charge_percentage": 53.2000, "estimated_amount": 9285, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 4023.47, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 4023, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14697.6, "standard_charge_percentage": 80.0000, "estimated_amount": 14697, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 468.65, "estimated_amount": 468, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4795.09, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4795, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 13779, "standard_charge_percentage": 75.0000, "estimated_amount": 13779, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 14697.6, "standard_charge_percentage": 80.0000, "estimated_amount": 14697, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 13044.1, "standard_charge_percentage": 71.0000, "estimated_amount": 13044, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" }]}]} , { "description": "EXC FOREARM LES SC < 3 CM", "code_information": [ { "code": "25075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8528, "discounted_cash": 2195,"minimum": 488,"maximum": 7078.24,"payers_information":[{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2240.27, "estimated_amount": 2240, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2225.81, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2225, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5543.2, "standard_charge_percentage": 65.0000, "estimated_amount": 5543, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7078.24, "standard_charge_percentage": 83.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1705.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2558.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2558, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4660.82, "estimated_amount": 4660, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6396, "standard_charge_percentage": 75.0000, "estimated_amount": 6396, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 536.93, "estimated_amount": 536, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2240.27, "estimated_amount": 2240, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4334.56, "estimated_amount": 4334, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5969.6, "standard_charge_percentage": 70.0000, "estimated_amount": 5969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2133.59, "estimated_amount": 2133, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2345.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2345, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6054.88, "standard_charge_percentage": 71.0000, "estimated_amount": 6054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4427.78, "estimated_amount": 4427, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2899.52, "standard_charge_percentage": 34.0000, "estimated_amount": 2899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 536.93, "estimated_amount": 536, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" }]}]} , { "description": "REMOVE WRIST TENDON LESION", "code_information": [ { "code": "25111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9760, "discounted_cash": 2168,"minimum": 355.61,"maximum": 8100.8,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 6344, "standard_charge_percentage": 65.0000, "estimated_amount": 6344, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7808, "standard_charge_percentage": 80.0000, "estimated_amount": 7808, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 7320, "standard_charge_percentage": 75.0000, "estimated_amount": 7320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4736.09, "estimated_amount": 4736, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2137.44, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2684, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2684, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2928, "standard_charge_percentage": 30.0000, "estimated_amount": 2928, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4985.36, "estimated_amount": 4985, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6929.6, "standard_charge_percentage": 71.0000, "estimated_amount": 6929, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2137.44, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2137, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 8100.8, "standard_charge_percentage": 83.0000, "estimated_amount": 8100, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6832, "standard_charge_percentage": 70.0000, "estimated_amount": 6832, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 7808, "standard_charge_percentage": 80.0000, "estimated_amount": 7808, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2547.36, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2547, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4636.38, "estimated_amount": 4636, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3318.4, "standard_charge_percentage": 34.0000, "estimated_amount": 3318, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1720.24, "estimated_amount": 1720, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 7808, "standard_charge_percentage": 80.0000, "estimated_amount": 7808, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1720.24, "estimated_amount": 1720, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 355.61, "estimated_amount": 355, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7808, "standard_charge_percentage": 80.0000, "estimated_amount": 7808, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 355.61, "estimated_amount": 355, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1952, "standard_charge_percentage": 20.0000, "estimated_amount": 1952, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2137.44, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 7808, "standard_charge_percentage": 80.0000, "estimated_amount": 7808, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "25405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14580, "discounted_cash": 9680,"minimum": 690,"maximum": 14580,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3193.02, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 7226.17, "estimated_amount": 7226, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 12101.4, "standard_charge_percentage": 83.0000, "estimated_amount": 12101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6882.07, "estimated_amount": 6882, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6882.07, "estimated_amount": 6882, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11664, "standard_charge_percentage": 80.0000, "estimated_amount": 11664, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 11664, "standard_charge_percentage": 80.0000, "estimated_amount": 11664, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6882.07, "estimated_amount": 6882, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4374, "standard_charge_percentage": 30.0000, "estimated_amount": 4374, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3805.38, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3805, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 10351.8, "standard_charge_percentage": 71.0000, "estimated_amount": 10351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1132.58, "estimated_amount": 1132, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1132.58, "estimated_amount": 1132, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6882.07, "estimated_amount": 6882, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6882.07, "estimated_amount": 6882, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 11664, "standard_charge_percentage": 80.0000, "estimated_amount": 11664, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 10206, "standard_charge_percentage": 70.0000, "estimated_amount": 10206, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6882.07, "estimated_amount": 6882, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 7755.38, "estimated_amount": 7755, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4009.5, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11664, "standard_charge_percentage": 80.0000, "estimated_amount": 11664, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9477, "standard_charge_percentage": 65.0000, "estimated_amount": 9477, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 10935, "standard_charge_percentage": 75.0000, "estimated_amount": 10935, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 14580, "estimated_amount": 14580, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2916, "standard_charge_percentage": 20.0000, "estimated_amount": 2916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4957.2, "standard_charge_percentage": 34.0000, "estimated_amount": 4957, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 7226.17, "estimated_amount": 7226, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7367.61, "estimated_amount": 7367, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3193.02, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3193, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3193.02, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 11664, "standard_charge_percentage": 80.0000, "estimated_amount": 11664, "methodology": "percent of total billed charges" }]}]} , { "description": "Arthrp Ntrcrp/Crp/Mtcr Ntrps", "code_information": [ { "code": "25447", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23352, "discounted_cash": 4396,"minimum": 785,"maximum": 19382.2,"payers_information":[{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 7939.68, "standard_charge_percentage": 34.0000, "estimated_amount": 7939, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 4252.85, "estimated_amount": 4252, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 9600.72, "estimated_amount": 9600, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 785, "estimated_amount": 785, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4465.49, "estimated_amount": 4465, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 16579.9, "standard_charge_percentage": 71.0000, "estimated_amount": 16579, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 17514, "standard_charge_percentage": 75.0000, "estimated_amount": 17514, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 5150, "estimated_amount": 5150, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 4252.85, "estimated_amount": 4252, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 4670.4, "standard_charge_percentage": 20.0000, "estimated_amount": 4670, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 19382.2, "standard_charge_percentage": 83.0000, "estimated_amount": 19382, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 5114.09, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 5114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 871.33, "estimated_amount": 871, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 15178.8, "standard_charge_percentage": 65.0000, "estimated_amount": 15178, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 5114.09, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 5114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 4252.85, "estimated_amount": 4252, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 9807.19, "estimated_amount": 9807, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4252.85, "estimated_amount": 4252, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 5114.09, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 5114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7005.6, "standard_charge_percentage": 30.0000, "estimated_amount": 7005, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 871.33, "estimated_amount": 871, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 6421.8, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 6421, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 10323.4, "estimated_amount": 10323, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 4252.85, "estimated_amount": 4252, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 16346.4, "standard_charge_percentage": 70.0000, "estimated_amount": 16346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4465.49, "estimated_amount": 4465, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 4252.85, "estimated_amount": 4252, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "25565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8472, "discounted_cash": 2168,"minimum": 483.81,"maximum": 7031.76,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1855.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1855, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1855.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1855, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6015.12, "standard_charge_percentage": 71.0000, "estimated_amount": 6015, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 572.68, "estimated_amount": 572, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6777.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6777, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2541.6, "standard_charge_percentage": 30.0000, "estimated_amount": 2541, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2329.8, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2329, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5930.4, "standard_charge_percentage": 70.0000, "estimated_amount": 5930, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6354, "standard_charge_percentage": 75.0000, "estimated_amount": 6354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2880.48, "standard_charge_percentage": 34.0000, "estimated_amount": 2880, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6777.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6777, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5506.8, "standard_charge_percentage": 65.0000, "estimated_amount": 5506, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1855.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1855, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2211.19, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2211, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 572.68, "estimated_amount": 572, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6777.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6777, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6777.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6777, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6777.6, "standard_charge_percentage": 80.0000, "estimated_amount": 6777, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1694.4, "standard_charge_percentage": 20.0000, "estimated_amount": 1694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7031.76, "standard_charge_percentage": 83.0000, "estimated_amount": 7031, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" }]}]} , { "description": "Treat fracture radiusulna", "code_information": [ { "code": "25605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4366, "discounted_cash": 2168,"minimum": 483.81,"maximum": 3805.04,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2837.9, "standard_charge_percentage": 65.0000, "estimated_amount": 2837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1200.65, "standard_charge_percentage": 27.5000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1309.8, "standard_charge_percentage": 30.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1484.44, "standard_charge_percentage": 34.0000, "estimated_amount": 1484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3099.86, "standard_charge_percentage": 71.0000, "estimated_amount": 3099, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3274.5, "standard_charge_percentage": 75.0000, "estimated_amount": 3274, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 873.2, "standard_charge_percentage": 20.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1139.53, "standard_charge_percentage": 26.1000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3580.12, "standard_charge_percentage": 82.0000, "estimated_amount": 3580, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 596.54, "estimated_amount": 596, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3056.2, "standard_charge_percentage": 70.0000, "estimated_amount": 3056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 596.54, "estimated_amount": 596, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3623.78, "standard_charge_percentage": 83.0000, "estimated_amount": 3623, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" }]}]} , { "description": "Treat fx distal radial", "code_information": [ { "code": "25606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11608, "discounted_cash": 4396,"minimum": 558,"maximum": 9634.64,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 733.45, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 733.45, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 8706, "standard_charge_percentage": 75.0000, "estimated_amount": 8706, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3482.4, "standard_charge_percentage": 30.0000, "estimated_amount": 3482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 8241.68, "standard_charge_percentage": 71.0000, "estimated_amount": 8241, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2542.15, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2542, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9286.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9286, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 7877.83, "estimated_amount": 7877, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 9286.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9286, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3946.72, "standard_charge_percentage": 34.0000, "estimated_amount": 3946, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 9634.64, "standard_charge_percentage": 83.0000, "estimated_amount": 9634, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 7326.38, "estimated_amount": 7326, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7545.2, "standard_charge_percentage": 65.0000, "estimated_amount": 7545, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2542.15, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 8125.6, "standard_charge_percentage": 70.0000, "estimated_amount": 8125, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3029.69, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3029, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9286.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9286, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3714.56, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 3714, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 9286.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9286, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 9286.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9286, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7483.94, "estimated_amount": 7483, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2321.6, "standard_charge_percentage": 20.0000, "estimated_amount": 2321, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3192.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2542.15, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2542, "methodology": "percent of total billed charges" }]}]} , { "description": "Optx Dst Rd Xartc Fx/Epi Sep", "code_information": [ { "code": "25607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30878, "discounted_cash": 9680,"minimum": 785,"maximum": 25628.7,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 24702.4, "standard_charge_percentage": 80.0000, "estimated_amount": 24702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 24702.4, "standard_charge_percentage": 80.0000, "estimated_amount": 24702, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 812.66, "estimated_amount": 812, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9263.4, "standard_charge_percentage": 30.0000, "estimated_amount": 9263, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8491.45, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16775.2, "estimated_amount": 16775, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 24702.4, "standard_charge_percentage": 80.0000, "estimated_amount": 24702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 10498.5, "standard_charge_percentage": 34.0000, "estimated_amount": 10498, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 6175.6, "standard_charge_percentage": 20.0000, "estimated_amount": 6175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 20070.7, "standard_charge_percentage": 65.0000, "estimated_amount": 20070, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 17658.1, "estimated_amount": 17658, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 23158.5, "standard_charge_percentage": 75.0000, "estimated_amount": 23158, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 21923.4, "standard_charge_percentage": 71.0000, "estimated_amount": 21923, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 24702.4, "standard_charge_percentage": 80.0000, "estimated_amount": 24702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 812.66, "estimated_amount": 812, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 25628.7, "standard_charge_percentage": 83.0000, "estimated_amount": 25628, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 9528, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 9528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 24702.4, "standard_charge_percentage": 80.0000, "estimated_amount": 24702, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 16422, "estimated_amount": 16422, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 21614.6, "standard_charge_percentage": 70.0000, "estimated_amount": 21614, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 785, "estimated_amount": 785, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" }]}]} , { "description": "Optx dst rd xart fx/epi sep2", "code_information": [ { "code": "25608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20875, "discounted_cash": 9680,"minimum": 785,"maximum": 17658.1,"payers_information":[{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 16700, "standard_charge_percentage": 80.0000, "estimated_amount": 16700, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 785, "estimated_amount": 785, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 13568.8, "standard_charge_percentage": 65.0000, "estimated_amount": 13568, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 15656.3, "standard_charge_percentage": 75.0000, "estimated_amount": 15656, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 5740.63, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 5740, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 905.96, "estimated_amount": 905, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 14612.5, "standard_charge_percentage": 70.0000, "estimated_amount": 14612, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 4175, "standard_charge_percentage": 20.0000, "estimated_amount": 4175, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5448.38, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5448, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 4571.62, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 4571, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16775.2, "estimated_amount": 16775, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 14821.3, "standard_charge_percentage": 71.0000, "estimated_amount": 14821, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 16700, "standard_charge_percentage": 80.0000, "estimated_amount": 16700, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 16422, "estimated_amount": 16422, "methodology": "case rate" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 6680, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 6680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6262.5, "standard_charge_percentage": 30.0000, "estimated_amount": 6262, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 16700, "standard_charge_percentage": 80.0000, "estimated_amount": 16700, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 16700, "standard_charge_percentage": 80.0000, "estimated_amount": 16700, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 17326.3, "standard_charge_percentage": 83.0000, "estimated_amount": 17326, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 17658.1, "estimated_amount": 17658, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 7097.5, "standard_charge_percentage": 34.0000, "estimated_amount": 7097, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 905.96, "estimated_amount": 905, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 16700, "standard_charge_percentage": 80.0000, "estimated_amount": 16700, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 4571.62, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 4571, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 4571.62, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 4571, "methodology": "percent of total billed charges" }]}]} , { "description": "Optx dst rd xart fx/ep sep3+", "code_information": [ { "code": "25609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27657, "discounted_cash": 9680,"minimum": 785,"maximum": 22955.3,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 17977, "standard_charge_percentage": 65.0000, "estimated_amount": 17977, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 22955.3, "standard_charge_percentage": 83.0000, "estimated_amount": 22955, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6056.88, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6056, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 8850.24, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 8850, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 20742.8, "standard_charge_percentage": 75.0000, "estimated_amount": 20742, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 22125.6, "standard_charge_percentage": 80.0000, "estimated_amount": 22125, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 7605.68, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 7605, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1149.55, "estimated_amount": 1149, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8297.1, "standard_charge_percentage": 30.0000, "estimated_amount": 8297, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6056.88, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 22125.6, "standard_charge_percentage": 80.0000, "estimated_amount": 22125, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 19636.5, "standard_charge_percentage": 71.0000, "estimated_amount": 19636, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 9403.38, "standard_charge_percentage": 34.0000, "estimated_amount": 9403, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6056.88, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 5531.4, "standard_charge_percentage": 20.0000, "estimated_amount": 5531, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 19359.9, "standard_charge_percentage": 70.0000, "estimated_amount": 19359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1149.55, "estimated_amount": 1149, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 22125.6, "standard_charge_percentage": 80.0000, "estimated_amount": 22125, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 22125.6, "standard_charge_percentage": 80.0000, "estimated_amount": 22125, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 17658.1, "estimated_amount": 17658, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 22125.6, "standard_charge_percentage": 80.0000, "estimated_amount": 22125, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16775.2, "estimated_amount": 16775, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 16422, "estimated_amount": 16422, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 785, "estimated_amount": 785, "methodology": "case rate" }]}]} , { "description": "Treat wrist bone fracture", "code_information": [ { "code": "25628", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26770, "discounted_cash": 9680,"minimum": 558,"maximum": 22219.1,"payers_information":[{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 5862.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 5862, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 21416, "standard_charge_percentage": 80.0000, "estimated_amount": 21416, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 18739, "standard_charge_percentage": 70.0000, "estimated_amount": 18739, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 17400.5, "standard_charge_percentage": 65.0000, "estimated_amount": 17400, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 20077.5, "standard_charge_percentage": 75.0000, "estimated_amount": 20077, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8031, "standard_charge_percentage": 30.0000, "estimated_amount": 8031, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 21416, "standard_charge_percentage": 80.0000, "estimated_amount": 21416, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 9101.8, "standard_charge_percentage": 34.0000, "estimated_amount": 9101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11005.7, "estimated_amount": 11005, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 11584.9, "estimated_amount": 11584, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 21416, "standard_charge_percentage": 80.0000, "estimated_amount": 21416, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 10774, "estimated_amount": 10773, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 19006.7, "standard_charge_percentage": 71.0000, "estimated_amount": 19006, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 21416, "standard_charge_percentage": 80.0000, "estimated_amount": 21416, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 7361.75, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 7361, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 5354, "standard_charge_percentage": 20.0000, "estimated_amount": 5354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 22219.1, "standard_charge_percentage": 83.0000, "estimated_amount": 22219, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 785.88, "estimated_amount": 785, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 21416, "standard_charge_percentage": 80.0000, "estimated_amount": 21416, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 5862.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 5862, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 785.88, "estimated_amount": 785, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 5862.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 5862, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" }]}]} , { "description": "Hc Drain Finger Abscess Simple", "code_information": [ { "code": "26010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 301, "discounted_cash": 269,"minimum": 60.2,"maximum": 301,"payers_information":[{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 301, "estimated_amount": 301, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 301, "estimated_amount": 301, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 258.9, "estimated_amount": 258, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 227.83, "estimated_amount": 227, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 202.98, "estimated_amount": 202, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 301, "estimated_amount": 301, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 240.8, "standard_charge_percentage": 80.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 213.71, "standard_charge_percentage": 71.0000, "estimated_amount": 213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 195.65, "standard_charge_percentage": 65.0000, "estimated_amount": 195, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 301, "estimated_amount": 301, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 301, "estimated_amount": 301, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 301, "estimated_amount": 301, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 301, "estimated_amount": 301, "methodology": "case rate" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 96.32, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 96, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 65.92, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 65, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 65.92, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 65, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 249.83, "standard_charge_percentage": 83.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 240.8, "standard_charge_percentage": 80.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 289.97, "estimated_amount": 289, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 78.56, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 78, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 240.8, "standard_charge_percentage": 80.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 279.61, "estimated_amount": 279, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 75.25, "standard_charge_percentage": 25.0000, "estimated_amount": 75, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 238.19, "estimated_amount": 238, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 301, "estimated_amount": 301, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 145.38, "standard_charge_percentage": 48.3000, "estimated_amount": 145, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 301, "estimated_amount": 301, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 240.8, "standard_charge_percentage": 80.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 301, "estimated_amount": 301, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 207.33, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 213.33, "estimated_amount": 213, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 90.3, "standard_charge_percentage": 30.0000, "estimated_amount": 90, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 65.92, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 65, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 217.48, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 60.2, "standard_charge_percentage": 20.0000, "estimated_amount": 60, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 248.54, "estimated_amount": 248, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 102.34, "standard_charge_percentage": 34.0000, "estimated_amount": 102, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 207.12, "estimated_amount": 207, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 82.78, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 82, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 210.7, "standard_charge_percentage": 70.0000, "estimated_amount": 210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 240.8, "standard_charge_percentage": 80.0000, "estimated_amount": 240, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 225.75, "standard_charge_percentage": 75.0000, "estimated_amount": 225, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 196.76, "estimated_amount": 196, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 217.7, "estimated_amount": 217, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 301, "estimated_amount": 301, "methodology": "case rate" }]}]} , { "description": "Release palm contracture", "code_information": [ { "code": "26045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10068, "discounted_cash": 4396,"minimum": 518.2,"maximum": 8356.44,"payers_information":[{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2627.75, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2627, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 518.2, "estimated_amount": 518, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 6544.2, "standard_charge_percentage": 65.0000, "estimated_amount": 6544, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3020.4, "standard_charge_percentage": 30.0000, "estimated_amount": 3020, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 7551, "standard_charge_percentage": 75.0000, "estimated_amount": 7551, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2204.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7586.38, "estimated_amount": 7586, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3423.12, "standard_charge_percentage": 34.0000, "estimated_amount": 3423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7148.28, "standard_charge_percentage": 71.0000, "estimated_amount": 7148, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 518.2, "estimated_amount": 518, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2204.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 8356.44, "standard_charge_percentage": 83.0000, "estimated_amount": 8356, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 7985.66, "estimated_amount": 7985, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1720.24, "estimated_amount": 1720, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 7426.66, "estimated_amount": 7426, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2013.6, "standard_charge_percentage": 20.0000, "estimated_amount": 2013, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1720.24, "estimated_amount": 1720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2204.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2204, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2768.7, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2768, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7047.6, "standard_charge_percentage": 70.0000, "estimated_amount": 7047, "methodology": "percent of total billed charges" }]}]} , { "description": "Incise finger tendon sheath", "code_information": [ { "code": "26055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8368, "discounted_cash": 2168,"minimum": 488,"maximum": 6945.44,"payers_information":[{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4985.36, "estimated_amount": 4985, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 600.42, "estimated_amount": 600, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6276, "standard_charge_percentage": 75.0000, "estimated_amount": 6276, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2184.05, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1720.24, "estimated_amount": 1720, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6694, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1832.59, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1832, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2301.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2301, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 600.42, "estimated_amount": 600, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 5941.28, "standard_charge_percentage": 71.0000, "estimated_amount": 5941, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 6945.44, "standard_charge_percentage": 83.0000, "estimated_amount": 6945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5439.2, "standard_charge_percentage": 65.0000, "estimated_amount": 5439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4736.09, "estimated_amount": 4736, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1832.59, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1832, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1673.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1673, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6694, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4636.38, "estimated_amount": 4636, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2845.12, "standard_charge_percentage": 34.0000, "estimated_amount": 2845, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2510.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2510, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6694, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1832.59, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1832, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5857.6, "standard_charge_percentage": 70.0000, "estimated_amount": 5857, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1720.24, "estimated_amount": 1720, "methodology": "fee schedule" }]}]} , { "description": "Exc hand tum deep 1.5 cm>", "code_information": [ { "code": "26113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13148, "discounted_cash": 2195,"minimum": 599,"maximum": 10912.8,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9861, "standard_charge_percentage": 75.0000, "estimated_amount": 9861, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4207.36, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 4207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2879.41, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6645, "standard_charge_percentage": 53.2000, "estimated_amount": 6645, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10518, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8546.2, "standard_charge_percentage": 65.0000, "estimated_amount": 8546, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2629.6, "standard_charge_percentage": 20.0000, "estimated_amount": 2629, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 599, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2879.41, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2879, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 6505.1, "standard_charge_percentage": 53.2000, "estimated_amount": 6505, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2879.41, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2879, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1467, "estimated_amount": 1467, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10912.8, "standard_charge_percentage": 83.0000, "estimated_amount": 10912, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9335.08, "standard_charge_percentage": 71.0000, "estimated_amount": 9335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9203.6, "standard_charge_percentage": 70.0000, "estimated_amount": 9203, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6994.74, "standard_charge_percentage": 53.2000, "estimated_amount": 6994, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4470.32, "standard_charge_percentage": 34.0000, "estimated_amount": 4470, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3431.63, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3431, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1720.24, "estimated_amount": 1720, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3944.4, "standard_charge_percentage": 30.0000, "estimated_amount": 3944, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1720.24, "estimated_amount": 1720, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3615.7, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3615, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 599, "estimated_amount": 599, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 10518, "methodology": "percent of total billed charges" }]}]} , { "description": "Exc hand les sc < 1.5 cm", "code_information": [ { "code": "26115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8109.33, "discounted_cash": 2195,"minimum": 488,"maximum": 6730.74,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 5757.62, "standard_charge_percentage": 71.0000, "estimated_amount": 5757, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5271.06, "standard_charge_percentage": 65.0000, "estimated_amount": 5271, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2230.07, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6487.46, "standard_charge_percentage": 80.0000, "estimated_amount": 6487, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6487.46, "standard_charge_percentage": 80.0000, "estimated_amount": 6487, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 569.41, "estimated_amount": 569, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1775.94, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1775, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1775.94, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1720.24, "estimated_amount": 1720, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5759.08, "estimated_amount": 5759, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2432.8, "standard_charge_percentage": 30.0000, "estimated_amount": 2432, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2116.54, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2116, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 6730.74, "standard_charge_percentage": 83.0000, "estimated_amount": 6730, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6487.46, "standard_charge_percentage": 80.0000, "estimated_amount": 6487, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 569.41, "estimated_amount": 569, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5676.53, "standard_charge_percentage": 70.0000, "estimated_amount": 5676, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1775.94, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1775, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1621.87, "standard_charge_percentage": 20.0000, "estimated_amount": 1621, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2757.17, "standard_charge_percentage": 34.0000, "estimated_amount": 2757, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6192.56, "estimated_amount": 6192, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1720.24, "estimated_amount": 1720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5882.93, "estimated_amount": 5882, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6082, "standard_charge_percentage": 75.0000, "estimated_amount": 6082, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6487.46, "standard_charge_percentage": 80.0000, "estimated_amount": 6487, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6487.46, "standard_charge_percentage": 80.0000, "estimated_amount": 6487, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26087, "discounted_cash": 4396,"minimum": 655.82,"maximum": 21652.2,"payers_information":[{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 18260.9, "standard_charge_percentage": 70.0000, "estimated_amount": 18260, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 655.82, "estimated_amount": 655, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 7173.93, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 7173, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2701.73, "estimated_amount": 2701, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 655.82, "estimated_amount": 655, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 20869.6, "standard_charge_percentage": 80.0000, "estimated_amount": 20869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 20869.6, "standard_charge_percentage": 80.0000, "estimated_amount": 20869, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2701.73, "estimated_amount": 2701, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 7426.66, "estimated_amount": 7426, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2836.82, "estimated_amount": 2836, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 5713.05, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 5713, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2701.73, "estimated_amount": 2701, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7586.38, "estimated_amount": 7586, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 5713.05, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 5713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20869.6, "standard_charge_percentage": 80.0000, "estimated_amount": 20869, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 20869.6, "standard_charge_percentage": 80.0000, "estimated_amount": 20869, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 21652.2, "standard_charge_percentage": 83.0000, "estimated_amount": 21652, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2701.73, "estimated_amount": 2701, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7826.1, "standard_charge_percentage": 30.0000, "estimated_amount": 7826, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 8869.58, "standard_charge_percentage": 34.0000, "estimated_amount": 8869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 7985.66, "estimated_amount": 7985, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 20869.6, "standard_charge_percentage": 80.0000, "estimated_amount": 20869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 18521.8, "standard_charge_percentage": 71.0000, "estimated_amount": 18521, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 5713.05, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 5713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2701.73, "estimated_amount": 2701, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 16956.5, "standard_charge_percentage": 65.0000, "estimated_amount": 16956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2836.82, "estimated_amount": 2836, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2701.73, "estimated_amount": 2701, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 5217.4, "standard_charge_percentage": 20.0000, "estimated_amount": 5217, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 19565.3, "standard_charge_percentage": 75.0000, "estimated_amount": 19565, "methodology": "percent of total billed charges" }]}]} , { "description": "Remove tendon sheath lesion", "code_information": [ { "code": "26160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7889, "discounted_cash": 2168,"minimum": 558,"maximum": 6547.87,"payers_information":[{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1720.24, "estimated_amount": 1720, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 6547.87, "standard_charge_percentage": 83.0000, "estimated_amount": 6547, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4985.36, "estimated_amount": 4985, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1720.24, "estimated_amount": 1720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2169.47, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2169, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 5601.19, "standard_charge_percentage": 71.0000, "estimated_amount": 5601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4636.38, "estimated_amount": 4636, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1727.69, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1727, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2366.7, "standard_charge_percentage": 30.0000, "estimated_amount": 2366, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2682.26, "standard_charge_percentage": 34.0000, "estimated_amount": 2682, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1577.8, "standard_charge_percentage": 20.0000, "estimated_amount": 1577, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6311.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2059.03, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2059, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6311.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5916.75, "standard_charge_percentage": 75.0000, "estimated_amount": 5916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6311.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6311, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6311.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6311, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5522.3, "standard_charge_percentage": 70.0000, "estimated_amount": 5522, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 628.26, "estimated_amount": 628, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1727.69, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1727, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1727.69, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1727, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4736.09, "estimated_amount": 4736, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6311.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 628.26, "estimated_amount": 628, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5127.85, "standard_charge_percentage": 65.0000, "estimated_amount": 5127, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" }]}]} , { "description": "Repair fingerhand tendon", "code_information": [ { "code": "26350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6233.4, "discounted_cash": 4396,"minimum": 365,"maximum": 6233.4,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1626.92, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1626, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6233.4, "estimated_amount": 6233, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1365.11, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1365, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2119.36, "standard_charge_percentage": 34.0000, "estimated_amount": 2119, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4675.05, "standard_charge_percentage": 75.0000, "estimated_amount": 4675, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4986.72, "standard_charge_percentage": 80.0000, "estimated_amount": 4986, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6233.4, "estimated_amount": 6233, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1365.11, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1365, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1720.24, "estimated_amount": 1720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1720.24, "estimated_amount": 1720, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 6233.4, "estimated_amount": 6233, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4986.72, "standard_charge_percentage": 80.0000, "estimated_amount": 4986, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6233.4, "estimated_amount": 6233, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4363.38, "standard_charge_percentage": 70.0000, "estimated_amount": 4363, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1638.32, "estimated_amount": 1638, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 781.63, "estimated_amount": 781, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1442, "estimated_amount": 1442, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4986.72, "standard_charge_percentage": 80.0000, "estimated_amount": 4986, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1870.02, "standard_charge_percentage": 30.0000, "estimated_amount": 1870, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4986.72, "standard_charge_percentage": 80.0000, "estimated_amount": 4986, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4986.72, "standard_charge_percentage": 80.0000, "estimated_amount": 4986, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1246.68, "standard_charge_percentage": 20.0000, "estimated_amount": 1246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4051.71, "standard_charge_percentage": 65.0000, "estimated_amount": 4051, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4425.71, "standard_charge_percentage": 71.0000, "estimated_amount": 4425, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5173.72, "standard_charge_percentage": 83.0000, "estimated_amount": 5173, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1365.11, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1365, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 781.63, "estimated_amount": 781, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1714.18, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1714, "methodology": "percent of total billed charges" }]}]} , { "description": "Repair fingerhand tendon", "code_information": [ { "code": "26426", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14688, "discounted_cash": 4396,"minimum": 551.25,"maximum": 12191,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3833.57, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3833, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2701.73, "estimated_amount": 2701, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4406.4, "standard_charge_percentage": 30.0000, "estimated_amount": 4406, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11750.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11750, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 10428.5, "standard_charge_percentage": 71.0000, "estimated_amount": 10428, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 10281.6, "standard_charge_percentage": 70.0000, "estimated_amount": 10281, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4039.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4039, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11750.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11750, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2701.73, "estimated_amount": 2701, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3216.67, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3216, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 551.25, "estimated_amount": 551, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 11750.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11750, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3216.67, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3216, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 12191, "standard_charge_percentage": 83.0000, "estimated_amount": 12191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7586.38, "estimated_amount": 7586, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9547.2, "standard_charge_percentage": 65.0000, "estimated_amount": 9547, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2937.6, "standard_charge_percentage": 20.0000, "estimated_amount": 2937, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 11750.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11750, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4993.92, "standard_charge_percentage": 34.0000, "estimated_amount": 4993, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 11016, "standard_charge_percentage": 75.0000, "estimated_amount": 11016, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 551.25, "estimated_amount": 551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2701.73, "estimated_amount": 2701, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2701.73, "estimated_amount": 2701, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2701.73, "estimated_amount": 2701, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 7985.66, "estimated_amount": 7985, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3216.67, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3216, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 7426.66, "estimated_amount": 7426, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2836.82, "estimated_amount": 2836, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2701.73, "estimated_amount": 2701, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 11750.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11750, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2836.82, "estimated_amount": 2836, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9498.34, "discounted_cash": 4396,"minimum": 481.75,"maximum": 9498.34,"payers_information":[{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6648.84, "standard_charge_percentage": 70.0000, "estimated_amount": 6648, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 4252.85, "estimated_amount": 4252, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2080.14, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4252.85, "estimated_amount": 4252, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 785, "estimated_amount": 785, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 6173.92, "standard_charge_percentage": 65.0000, "estimated_amount": 6173, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 4252.85, "estimated_amount": 4252, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2479.07, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2479, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 7598.67, "standard_charge_percentage": 80.0000, "estimated_amount": 7598, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 7598.67, "standard_charge_percentage": 80.0000, "estimated_amount": 7598, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 481.75, "estimated_amount": 481, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 7123.76, "standard_charge_percentage": 75.0000, "estimated_amount": 7123, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 4252.85, "estimated_amount": 4252, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 9498.34, "estimated_amount": 9498, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4465.49, "estimated_amount": 4465, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7598.67, "standard_charge_percentage": 80.0000, "estimated_amount": 7598, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6743.82, "standard_charge_percentage": 71.0000, "estimated_amount": 6743, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 4252.85, "estimated_amount": 4252, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3229.44, "standard_charge_percentage": 34.0000, "estimated_amount": 3229, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 9498.34, "estimated_amount": 9498, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2080.14, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2080, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7883.62, "standard_charge_percentage": 83.0000, "estimated_amount": 7883, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1899.67, "standard_charge_percentage": 20.0000, "estimated_amount": 1899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7598.67, "standard_charge_percentage": 80.0000, "estimated_amount": 7598, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 481.75, "estimated_amount": 481, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 9498.34, "estimated_amount": 9498, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2612.04, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2612, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2080.14, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 7598.67, "standard_charge_percentage": 80.0000, "estimated_amount": 7598, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 4252.85, "estimated_amount": 4252, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 5150, "estimated_amount": 5150, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2849.5, "standard_charge_percentage": 30.0000, "estimated_amount": 2849, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4465.49, "estimated_amount": 4465, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" }]}]} , { "description": "Reviseimplant finger joint", "code_information": [ { "code": "26536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28252, "discounted_cash": 9680,"minimum": 785,"maximum": 23449.2,"payers_information":[{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 4252.85, "estimated_amount": 4252, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 785, "estimated_amount": 785, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6187.19, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6187.19, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 13908, "estimated_amount": 13908, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 787.67, "estimated_amount": 787, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 22601.6, "standard_charge_percentage": 80.0000, "estimated_amount": 22601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 7769.3, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 7769, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 22601.6, "standard_charge_percentage": 80.0000, "estimated_amount": 22601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 19776.4, "standard_charge_percentage": 70.0000, "estimated_amount": 19776, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 9605.68, "standard_charge_percentage": 34.0000, "estimated_amount": 9605, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 18363.8, "standard_charge_percentage": 65.0000, "estimated_amount": 18363, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4465.49, "estimated_amount": 4465, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 21189, "standard_charge_percentage": 75.0000, "estimated_amount": 21189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 22601.6, "standard_charge_percentage": 80.0000, "estimated_amount": 22601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 4252.85, "estimated_amount": 4252, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8475.6, "standard_charge_percentage": 30.0000, "estimated_amount": 8475, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 23449.2, "standard_charge_percentage": 83.0000, "estimated_amount": 23449, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 5650.4, "standard_charge_percentage": 20.0000, "estimated_amount": 5650, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6187.19, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 5150, "estimated_amount": 5150, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 787.67, "estimated_amount": 787, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 4252.85, "estimated_amount": 4252, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4252.85, "estimated_amount": 4252, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 13615.2, "estimated_amount": 13615, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 4252.85, "estimated_amount": 4252, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 22601.6, "standard_charge_percentage": 80.0000, "estimated_amount": 22601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4465.49, "estimated_amount": 4465, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 22601.6, "standard_charge_percentage": 80.0000, "estimated_amount": 22601, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 4252.85, "estimated_amount": 4252, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 14640, "estimated_amount": 14640, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 20058.9, "standard_charge_percentage": 71.0000, "estimated_amount": 20058, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Metacarpal Fx W Manip Ea", "code_information": [ { "code": "26605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 695, "discounted_cash": 325,"minimum": 139,"maximum": 695,"payers_information":[{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 569.9, "standard_charge_percentage": 82.0000, "estimated_amount": 569, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 350.07, "estimated_amount": 350, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 139, "standard_charge_percentage": 20.0000, "estimated_amount": 139, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 312.56, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 337.57, "estimated_amount": 337, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 405.08, "estimated_amount": 405, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 208.5, "standard_charge_percentage": 30.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 362.88, "estimated_amount": 362, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 521.25, "standard_charge_percentage": 75.0000, "estimated_amount": 521, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 486.5, "standard_charge_percentage": 70.0000, "estimated_amount": 486, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 570.31, "estimated_amount": 570, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 375.07, "estimated_amount": 375, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 245.05, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 695, "estimated_amount": 695, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 362.88, "estimated_amount": 362, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 287.56, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 191.13, "standard_charge_percentage": 27.5000, "estimated_amount": 191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 236.3, "standard_charge_percentage": 34.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 576.85, "standard_charge_percentage": 83.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 237.55, "estimated_amount": 237, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 451.75, "standard_charge_percentage": 65.0000, "estimated_amount": 451, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 275.06, "estimated_amount": 275, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 300.06, "estimated_amount": 300, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 181.4, "standard_charge_percentage": 26.1000, "estimated_amount": 181, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 493.45, "standard_charge_percentage": 71.0000, "estimated_amount": 493, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" }]}]} , { "description": "Treat Metacarpal Fracture", "code_information": [ { "code": "26608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17118, "discounted_cash": 4396,"minimum": 524.97,"maximum": 14207.9,"payers_information":[{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 7326.38, "estimated_amount": 7326, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 11982.6, "standard_charge_percentage": 70.0000, "estimated_amount": 11982, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4707.45, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4707, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 7877.83, "estimated_amount": 7877, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 12838.5, "standard_charge_percentage": 75.0000, "estimated_amount": 12838, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 524.97, "estimated_amount": 524, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5135.4, "standard_charge_percentage": 30.0000, "estimated_amount": 5135, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7483.94, "estimated_amount": 7483, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3748.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3748, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3748.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3748, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5820.12, "standard_charge_percentage": 34.0000, "estimated_amount": 5820, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 524.97, "estimated_amount": 524, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 11126.7, "standard_charge_percentage": 65.0000, "estimated_amount": 11126, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3423.6, "standard_charge_percentage": 20.0000, "estimated_amount": 3423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4467.8, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3748.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3748, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 12153.8, "standard_charge_percentage": 71.0000, "estimated_amount": 12153, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 14207.9, "standard_charge_percentage": 83.0000, "estimated_amount": 14207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" }]}]} , { "description": "Treat metacarpal fracture", "code_information": [ { "code": "26615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9572, "discounted_cash": 4396,"minimum": 629.79,"maximum": 9572,"payers_information":[{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7657.6, "standard_charge_percentage": 80.0000, "estimated_amount": 7657, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 9572, "estimated_amount": 9572, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 7657.6, "standard_charge_percentage": 80.0000, "estimated_amount": 7657, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 629.79, "estimated_amount": 629, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 7657.6, "standard_charge_percentage": 80.0000, "estimated_amount": 7657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7657.6, "standard_charge_percentage": 80.0000, "estimated_amount": 7657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 7657.6, "standard_charge_percentage": 80.0000, "estimated_amount": 7657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 6221.8, "standard_charge_percentage": 65.0000, "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 629.79, "estimated_amount": 629, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2096.27, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2096, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2871.6, "standard_charge_percentage": 30.0000, "estimated_amount": 2871, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2096.27, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2096, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 9572, "estimated_amount": 9572, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2498.29, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2498, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1914.4, "standard_charge_percentage": 20.0000, "estimated_amount": 1914, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 7179, "standard_charge_percentage": 75.0000, "estimated_amount": 7179, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7944.76, "standard_charge_percentage": 83.0000, "estimated_amount": 7944, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2096.27, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2096, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3254.48, "standard_charge_percentage": 34.0000, "estimated_amount": 3254, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6700.4, "standard_charge_percentage": 70.0000, "estimated_amount": 6700, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 9572, "estimated_amount": 9572, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6796.12, "standard_charge_percentage": 71.0000, "estimated_amount": 6796, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2632.3, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2632, "methodology": "percent of total billed charges" }]}]} , { "description": "Treat hand dislocation", "code_information": [ { "code": "26675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25802, "discounted_cash": 2168,"minimum": 483.81,"maximum": 21415.7,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 5650.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 5650, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 7095.55, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 7095, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 20641.6, "standard_charge_percentage": 80.0000, "estimated_amount": 20641, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 510.5, "estimated_amount": 510, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 18061.4, "standard_charge_percentage": 70.0000, "estimated_amount": 18061, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 20641.6, "standard_charge_percentage": 80.0000, "estimated_amount": 20641, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 5160.4, "standard_charge_percentage": 20.0000, "estimated_amount": 5160, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 16771.3, "standard_charge_percentage": 65.0000, "estimated_amount": 16771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 5650.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 5650, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 21415.7, "standard_charge_percentage": 83.0000, "estimated_amount": 21415, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 20641.6, "standard_charge_percentage": 80.0000, "estimated_amount": 20641, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7740.6, "standard_charge_percentage": 30.0000, "estimated_amount": 7740, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 8772.68, "standard_charge_percentage": 34.0000, "estimated_amount": 8772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 19351.5, "standard_charge_percentage": 75.0000, "estimated_amount": 19351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 510.5, "estimated_amount": 510, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 20641.6, "standard_charge_percentage": 80.0000, "estimated_amount": 20641, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1272.63, "estimated_amount": 1272, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 18319.4, "standard_charge_percentage": 71.0000, "estimated_amount": 18319, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 20641.6, "standard_charge_percentage": 80.0000, "estimated_amount": 20641, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 5650.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 5650, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1272.63, "estimated_amount": 1272, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" }]}]} , { "description": "TREAT FINGER FRACTURE EACH", "code_information": [ { "code": "26725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 695, "discounted_cash": 325,"minimum": 139,"maximum": 606.49,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 337.57, "estimated_amount": 337, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 569.9, "standard_charge_percentage": 82.0000, "estimated_amount": 569, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 245.05, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 312.56, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 237.55, "estimated_amount": 237, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 350.07, "estimated_amount": 350, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 377.47, "estimated_amount": 377, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 287.56, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 451.75, "standard_charge_percentage": 65.0000, "estimated_amount": 451, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 405.08, "estimated_amount": 405, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 291.9, "standard_charge_percentage": 42.0000, "estimated_amount": 291, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 521.25, "standard_charge_percentage": 75.0000, "estimated_amount": 521, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 208.5, "standard_charge_percentage": 30.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 375.07, "estimated_amount": 375, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 236.3, "standard_charge_percentage": 34.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 570.31, "estimated_amount": 570, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 191.13, "standard_charge_percentage": 27.5000, "estimated_amount": 191, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 576.85, "standard_charge_percentage": 83.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 493.45, "standard_charge_percentage": 71.0000, "estimated_amount": 493, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 486.5, "standard_charge_percentage": 70.0000, "estimated_amount": 486, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 181.4, "standard_charge_percentage": 26.1000, "estimated_amount": 181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 275.06, "estimated_amount": 275, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 300.06, "estimated_amount": 300, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 173.75, "standard_charge_percentage": 25.0000, "estimated_amount": 173, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 377.47, "estimated_amount": 377, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 139, "standard_charge_percentage": 20.0000, "estimated_amount": 139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" }]}]} , { "description": "TREAT FINGER FRACTURE EACH", "code_information": [ { "code": "26735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16112, "discounted_cash": 4396,"minimum": 650.4,"maximum": 13373,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3528.53, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 10472.8, "standard_charge_percentage": 65.0000, "estimated_amount": 10472, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 11439.5, "standard_charge_percentage": 71.0000, "estimated_amount": 11439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12889.6, "standard_charge_percentage": 80.0000, "estimated_amount": 12889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 12084, "standard_charge_percentage": 75.0000, "estimated_amount": 12084, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 13373, "standard_charge_percentage": 83.0000, "estimated_amount": 13372, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3528.53, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 11584.9, "estimated_amount": 11584, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5478.08, "standard_charge_percentage": 34.0000, "estimated_amount": 5478, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12889.6, "standard_charge_percentage": 80.0000, "estimated_amount": 12889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 10774, "estimated_amount": 10773, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3528.53, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3528, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 650.4, "estimated_amount": 650, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 11278.4, "standard_charge_percentage": 70.0000, "estimated_amount": 11278, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11005.7, "estimated_amount": 11005, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4205.23, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4205, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 650.4, "estimated_amount": 650, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 12889.6, "standard_charge_percentage": 80.0000, "estimated_amount": 12889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 12889.6, "standard_charge_percentage": 80.0000, "estimated_amount": 12889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4833.6, "standard_charge_percentage": 30.0000, "estimated_amount": 4833, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3222.4, "standard_charge_percentage": 20.0000, "estimated_amount": 3222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 12889.6, "standard_charge_percentage": 80.0000, "estimated_amount": 12889, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4430.8, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" }]}]} , { "description": "Hc Clsd Treat Fingr Articular Fx W Manip Ea", "code_information": [ { "code": "26742", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4366, "discounted_cash": 2168,"minimum": 411.54,"maximum": 3805.04,"payers_information":[{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1139.53, "standard_charge_percentage": 26.1000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1309.8, "standard_charge_percentage": 30.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3623.78, "standard_charge_percentage": 83.0000, "estimated_amount": 3623, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3099.86, "standard_charge_percentage": 71.0000, "estimated_amount": 3099, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2837.9, "standard_charge_percentage": 65.0000, "estimated_amount": 2837, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3580.12, "standard_charge_percentage": 82.0000, "estimated_amount": 3580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 873.2, "standard_charge_percentage": 20.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3056.2, "standard_charge_percentage": 70.0000, "estimated_amount": 3056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1200.65, "standard_charge_percentage": 27.5000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1484.44, "standard_charge_percentage": 34.0000, "estimated_amount": 1484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 411.54, "estimated_amount": 411, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 411.54, "estimated_amount": 411, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3274.5, "standard_charge_percentage": 75.0000, "estimated_amount": 3274, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "26765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6381.33, "discounted_cash": 4396,"minimum": 549.57,"maximum": 6381.33,"payers_information":[{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4530.74, "standard_charge_percentage": 71.0000, "estimated_amount": 4530, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1665.53, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1665, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5105.06, "standard_charge_percentage": 80.0000, "estimated_amount": 5105, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6381.33, "estimated_amount": 6381, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6381.33, "estimated_amount": 6381, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6381.33, "estimated_amount": 6381, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4147.86, "standard_charge_percentage": 65.0000, "estimated_amount": 4147, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5105.06, "standard_charge_percentage": 80.0000, "estimated_amount": 5105, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6381.33, "estimated_amount": 6381, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1914.4, "standard_charge_percentage": 30.0000, "estimated_amount": 1914, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4466.93, "standard_charge_percentage": 70.0000, "estimated_amount": 4466, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5105.06, "standard_charge_percentage": 80.0000, "estimated_amount": 5105, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1397.51, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1397, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5105.06, "standard_charge_percentage": 80.0000, "estimated_amount": 5105, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1397.51, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1397, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 6381.33, "estimated_amount": 6381, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6381.33, "estimated_amount": 6381, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1754.87, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1754, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6381.33, "estimated_amount": 6381, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6381.33, "estimated_amount": 6381, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4786, "standard_charge_percentage": 75.0000, "estimated_amount": 4786, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 549.57, "estimated_amount": 549, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1276.27, "standard_charge_percentage": 20.0000, "estimated_amount": 1276, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6381.33, "estimated_amount": 6381, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 549.57, "estimated_amount": 549, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2169.65, "standard_charge_percentage": 34.0000, "estimated_amount": 2169, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1397.51, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1397, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5296.5, "standard_charge_percentage": 83.0000, "estimated_amount": 5296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5105.06, "standard_charge_percentage": 80.0000, "estimated_amount": 5105, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6381.33, "estimated_amount": 6381, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6381.33, "estimated_amount": 6381, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6381.33, "estimated_amount": 6381, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" }]}]} , { "description": "TREAT FINGER DISLOCATION", "code_information": [ { "code": "26770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 695, "discounted_cash": 325,"minimum": 139,"maximum": 606.49,"payers_information":[{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 236.3, "standard_charge_percentage": 34.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 375.07, "estimated_amount": 375, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 208.5, "standard_charge_percentage": 30.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 322.75, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 191.13, "standard_charge_percentage": 27.5000, "estimated_amount": 191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 287.56, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 569.9, "standard_charge_percentage": 82.0000, "estimated_amount": 569, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 570.31, "estimated_amount": 570, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 300.06, "estimated_amount": 300, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 237.55, "estimated_amount": 237, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 350.07, "estimated_amount": 350, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 291.9, "standard_charge_percentage": 42.0000, "estimated_amount": 291, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 181.4, "standard_charge_percentage": 26.1000, "estimated_amount": 181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 173.75, "standard_charge_percentage": 25.0000, "estimated_amount": 173, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 245.05, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 576.85, "standard_charge_percentage": 83.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 521.25, "standard_charge_percentage": 75.0000, "estimated_amount": 521, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 312.56, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 451.75, "standard_charge_percentage": 65.0000, "estimated_amount": 451, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 322.75, "estimated_amount": 322, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 275.06, "estimated_amount": 275, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 337.57, "estimated_amount": 337, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 405.08, "estimated_amount": 405, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 139, "standard_charge_percentage": 20.0000, "estimated_amount": 139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 493.45, "standard_charge_percentage": 71.0000, "estimated_amount": 493, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 486.5, "standard_charge_percentage": 70.0000, "estimated_amount": 486, "methodology": "percent of total billed charges" }]}]} , { "description": "AMPUTATION OF FINGERTHUMB", "code_information": [ { "code": "26952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6252.66, "discounted_cash": 4396,"minimum": 690,"maximum": 6252.66,"payers_information":[{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4689.49, "standard_charge_percentage": 75.0000, "estimated_amount": 4689, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1250.53, "standard_charge_percentage": 20.0000, "estimated_amount": 1250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4064.23, "standard_charge_percentage": 65.0000, "estimated_amount": 4064, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5189.71, "standard_charge_percentage": 83.0000, "estimated_amount": 5189, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2125.9, "standard_charge_percentage": 34.0000, "estimated_amount": 2125, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1369.33, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1369, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1369.33, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1369, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4985.36, "estimated_amount": 4985, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 723.85, "estimated_amount": 723, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 723.85, "estimated_amount": 723, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5002.13, "standard_charge_percentage": 80.0000, "estimated_amount": 5002, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1631.94, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1631, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2701.73, "estimated_amount": 2701, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1369.33, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1369, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2701.73, "estimated_amount": 2701, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4736.09, "estimated_amount": 4736, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2701.73, "estimated_amount": 2701, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2836.82, "estimated_amount": 2836, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5002.13, "standard_charge_percentage": 80.0000, "estimated_amount": 5002, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6252.66, "estimated_amount": 6252, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5002.13, "standard_charge_percentage": 80.0000, "estimated_amount": 5002, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5002.13, "standard_charge_percentage": 80.0000, "estimated_amount": 5002, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2701.73, "estimated_amount": 2701, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4636.38, "estimated_amount": 4636, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5002.13, "standard_charge_percentage": 80.0000, "estimated_amount": 5002, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1875.8, "standard_charge_percentage": 30.0000, "estimated_amount": 1875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2836.82, "estimated_amount": 2836, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2701.73, "estimated_amount": 2701, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1719.48, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1719, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4376.86, "standard_charge_percentage": 70.0000, "estimated_amount": 4376, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2701.73, "estimated_amount": 2701, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4439.39, "standard_charge_percentage": 71.0000, "estimated_amount": 4439, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13748.3,"minimum": 1420.63,"maximum": 11411.1,"payers_information":[{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9761.32, "standard_charge_percentage": 71.0000, "estimated_amount": 9761, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10998.7, "standard_charge_percentage": 80.0000, "estimated_amount": 10998, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 5220.4, "estimated_amount": 5220, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 5481.42, "estimated_amount": 5481, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 5220.4, "estimated_amount": 5220, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10998.7, "standard_charge_percentage": 80.0000, "estimated_amount": 10998, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3010.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2749.67, "standard_charge_percentage": 20.0000, "estimated_amount": 2749, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3010.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 3437.09, "standard_charge_percentage": 25.0000, "estimated_amount": 3437, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 10311.3, "standard_charge_percentage": 75.0000, "estimated_amount": 10311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1420.63, "estimated_amount": 1420, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8936.42, "standard_charge_percentage": 65.0000, "estimated_amount": 8936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5220.4, "estimated_amount": 5220, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 5220.4, "estimated_amount": 5220, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 6802.13, "standard_charge_percentage": 53.2000, "estimated_amount": 6802, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6948.41, "standard_charge_percentage": 53.2000, "estimated_amount": 6948, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 11411.1, "standard_charge_percentage": 83.0000, "estimated_amount": 11411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 5220.4, "estimated_amount": 5220, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3010.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1420.63, "estimated_amount": 1420, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4124.5, "standard_charge_percentage": 30.0000, "estimated_amount": 4124, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 5481.42, "estimated_amount": 5481, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4674.44, "standard_charge_percentage": 34.0000, "estimated_amount": 4674, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9623.84, "standard_charge_percentage": 70.0000, "estimated_amount": 9623, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 7314.12, "standard_charge_percentage": 53.2000, "estimated_amount": 7314, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3780.79, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3780, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3588.32, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3588, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 5220.4, "estimated_amount": 5220, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10998.7, "standard_charge_percentage": 80.0000, "estimated_amount": 10998, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10998.7, "standard_charge_percentage": 80.0000, "estimated_amount": 10998, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10998.7, "standard_charge_percentage": 80.0000, "estimated_amount": 10998, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4399.47, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 4399, "methodology": "percent of total billed charges" }]}]} , { "description": "Total hip arthroplasty", "code_information": [ { "code": "27130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41544, "discounted_cash": 17436,"minimum": 1406.49,"maximum": 34481.5,"payers_information":[{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 34481.5, "standard_charge_percentage": 83.0000, "estimated_amount": 34481, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2846, "estimated_amount": 2846, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 12742, "estimated_amount": 12742, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 29496.2, "standard_charge_percentage": 71.0000, "estimated_amount": 29496, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 9528, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 9528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 31158, "standard_charge_percentage": 75.0000, "estimated_amount": 31158, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 30591.5, "estimated_amount": 30591, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 29080.8, "standard_charge_percentage": 70.0000, "estimated_amount": 29080, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 33235.2, "standard_charge_percentage": 80.0000, "estimated_amount": 33235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 21728.5, "estimated_amount": 21728, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 12510.1, "estimated_amount": 12510, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 15424.5, "estimated_amount": 15424, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 18107, "estimated_amount": 18107, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 16095.2, "estimated_amount": 16095, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8889, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12463.2, "standard_charge_percentage": 30.0000, "estimated_amount": 12463, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 13144.4, "estimated_amount": 13144, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 20118.9, "estimated_amount": 20118, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 20996.3, "standard_charge_percentage": 53.2000, "estimated_amount": 20996, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 12510.1, "estimated_amount": 12510, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 33235.2, "standard_charge_percentage": 80.0000, "estimated_amount": 33235, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 20554.3, "standard_charge_percentage": 53.2000, "estimated_amount": 20554, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1406.49, "estimated_amount": 1406, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 16765.8, "estimated_amount": 16765, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1406.49, "estimated_amount": 1406, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 33235.2, "standard_charge_percentage": 80.0000, "estimated_amount": 33235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 10386, "standard_charge_percentage": 25.0000, "estimated_amount": 10386, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 33235.2, "standard_charge_percentage": 80.0000, "estimated_amount": 33235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 22101.4, "standard_charge_percentage": 53.2000, "estimated_amount": 22101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 14753.9, "estimated_amount": 14753, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 27003.6, "standard_charge_percentage": 65.0000, "estimated_amount": 27003, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 33235.2, "standard_charge_percentage": 80.0000, "estimated_amount": 33235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 14125, "standard_charge_percentage": 34.0000, "estimated_amount": 14124, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 8308.8, "standard_charge_percentage": 20.0000, "estimated_amount": 8308, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 18777.7, "estimated_amount": 18777, "methodology": "fee schedule" }]}]} , { "description": "Treat thigh fracture", "code_information": [ { "code": "27238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1035, "discounted_cash": 2168,"minimum": 207,"maximum": 1035,"payers_information":[{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 207, "standard_charge_percentage": 20.0000, "estimated_amount": 207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 310.5, "standard_charge_percentage": 30.0000, "estimated_amount": 310, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 828, "standard_charge_percentage": 80.0000, "estimated_amount": 828, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 828, "standard_charge_percentage": 80.0000, "estimated_amount": 828, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 351.9, "standard_charge_percentage": 34.0000, "estimated_amount": 351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 514.5, "estimated_amount": 514, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 724.5, "standard_charge_percentage": 70.0000, "estimated_amount": 724, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 672.75, "standard_charge_percentage": 65.0000, "estimated_amount": 672, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 270.13, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 270, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 828, "standard_charge_percentage": 80.0000, "estimated_amount": 828, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 284.63, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 284, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 776.25, "standard_charge_percentage": 75.0000, "estimated_amount": 776, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 226.66, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 828, "standard_charge_percentage": 80.0000, "estimated_amount": 828, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 859.05, "standard_charge_percentage": 83.0000, "estimated_amount": 859, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 514.5, "estimated_amount": 514, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 828, "standard_charge_percentage": 80.0000, "estimated_amount": 828, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1035, "estimated_amount": 1035, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 226.66, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 226.66, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 226, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 734.85, "standard_charge_percentage": 71.0000, "estimated_amount": 734, "methodology": "percent of total billed charges" }]}]} , { "description": "Treat thigh fracture", "code_information": [ { "code": "27245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30235,"minimum": 786.83,"maximum": 25095,"payers_information":[{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 24188, "standard_charge_percentage": 80.0000, "estimated_amount": 24188, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 19652.8, "standard_charge_percentage": 65.0000, "estimated_amount": 19652, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 25095, "standard_charge_percentage": 83.0000, "estimated_amount": 25095, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 24188, "standard_charge_percentage": 80.0000, "estimated_amount": 24188, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 16085, "standard_charge_percentage": 53.2000, "estimated_amount": 16085, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 5481.42, "estimated_amount": 5481, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 5220.4, "estimated_amount": 5220, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 24188, "standard_charge_percentage": 80.0000, "estimated_amount": 24188, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 14959.1, "standard_charge_percentage": 53.2000, "estimated_amount": 14959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 6047, "standard_charge_percentage": 20.0000, "estimated_amount": 6047, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 24188, "standard_charge_percentage": 80.0000, "estimated_amount": 24188, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 5481.42, "estimated_amount": 5481, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 9528, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 9528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1341.01, "estimated_amount": 1341, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 5220.4, "estimated_amount": 5220, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 21164.5, "standard_charge_percentage": 70.0000, "estimated_amount": 21164, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 15280.8, "standard_charge_percentage": 53.2000, "estimated_amount": 15280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 7558.75, "standard_charge_percentage": 25.0000, "estimated_amount": 7558, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 24188, "standard_charge_percentage": 80.0000, "estimated_amount": 24188, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9070.5, "standard_charge_percentage": 30.0000, "estimated_amount": 9070, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 5220.4, "estimated_amount": 5220, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 21466.8, "standard_charge_percentage": 71.0000, "estimated_amount": 21466, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 786.83, "estimated_amount": 786, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 10279.9, "standard_charge_percentage": 34.0000, "estimated_amount": 10279, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 5220.4, "estimated_amount": 5220, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8314.63, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8314, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 5220.4, "estimated_amount": 5220, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 22676.3, "standard_charge_percentage": 75.0000, "estimated_amount": 22676, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 786.83, "estimated_amount": 786, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5220.4, "estimated_amount": 5220, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1341.01, "estimated_amount": 1341, "methodology": "fee schedule" }]}]} , { "description": "Treat hip dislocation", "code_information": [ { "code": "27250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 550, "discounted_cash": 325,"minimum": 110,"maximum": 550,"payers_information":[{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 120.45, "standard_charge_percentage": 21.9000, "estimated_amount": 120, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 120.45, "standard_charge_percentage": 21.9000, "estimated_amount": 120, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 550, "estimated_amount": 550, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 202.13, "estimated_amount": 202, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 275.06, "estimated_amount": 275, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 550, "estimated_amount": 550, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 412.5, "standard_charge_percentage": 75.0000, "estimated_amount": 412, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 456.5, "standard_charge_percentage": 83.0000, "estimated_amount": 456, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 143.55, "standard_charge_percentage": 26.1000, "estimated_amount": 143, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 110, "standard_charge_percentage": 20.0000, "estimated_amount": 110, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 550, "estimated_amount": 550, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 550, "estimated_amount": 550, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 405.08, "estimated_amount": 405, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 550, "estimated_amount": 550, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 550, "estimated_amount": 550, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 312.56, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 202.13, "estimated_amount": 202, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 550, "estimated_amount": 550, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 390.5, "standard_charge_percentage": 71.0000, "estimated_amount": 390, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 120.45, "standard_charge_percentage": 21.9000, "estimated_amount": 120, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 550, "estimated_amount": 550, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 440, "standard_charge_percentage": 80.0000, "estimated_amount": 440, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 237.55, "estimated_amount": 237, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 187, "standard_charge_percentage": 34.0000, "estimated_amount": 187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 165, "standard_charge_percentage": 30.0000, "estimated_amount": 165, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 385, "standard_charge_percentage": 70.0000, "estimated_amount": 385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 451, "standard_charge_percentage": 82.0000, "estimated_amount": 451, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 550, "estimated_amount": 550, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 550, "estimated_amount": 550, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 337.57, "estimated_amount": 337, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 440, "standard_charge_percentage": 80.0000, "estimated_amount": 440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 287.56, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 440, "standard_charge_percentage": 80.0000, "estimated_amount": 440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 440, "standard_charge_percentage": 80.0000, "estimated_amount": 440, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 375.07, "estimated_amount": 375, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 350.07, "estimated_amount": 350, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 300.06, "estimated_amount": 300, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 440, "standard_charge_percentage": 80.0000, "estimated_amount": 440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 357.5, "standard_charge_percentage": 65.0000, "estimated_amount": 357, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 245.05, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 151.25, "standard_charge_percentage": 27.5000, "estimated_amount": 151, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" }]}]} , { "description": "Treat hip dislocation", "code_information": [ { "code": "27265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1182, "discounted_cash": 325,"minimum": 236.4,"maximum": 1182,"payers_information":[{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 570.31, "estimated_amount": 570, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 308.5, "standard_charge_percentage": 26.1000, "estimated_amount": 308, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1182, "estimated_amount": 1182, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 405.08, "estimated_amount": 405, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 258.86, "standard_charge_percentage": 21.9000, "estimated_amount": 258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 981.06, "standard_charge_percentage": 83.0000, "estimated_amount": 981, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 945.6, "standard_charge_percentage": 80.0000, "estimated_amount": 945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 350.07, "estimated_amount": 350, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 886.5, "standard_charge_percentage": 75.0000, "estimated_amount": 886, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 839.22, "standard_charge_percentage": 71.0000, "estimated_amount": 839, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 945.6, "standard_charge_percentage": 80.0000, "estimated_amount": 945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 312.56, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 945.6, "standard_charge_percentage": 80.0000, "estimated_amount": 945, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 827.4, "standard_charge_percentage": 70.0000, "estimated_amount": 827, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 245.05, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 258.86, "standard_charge_percentage": 21.9000, "estimated_amount": 258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 236.4, "standard_charge_percentage": 20.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 463.2, "estimated_amount": 463, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 325.05, "standard_charge_percentage": 27.5000, "estimated_amount": 325, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 275.06, "estimated_amount": 275, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 945.6, "standard_charge_percentage": 80.0000, "estimated_amount": 945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 375.07, "estimated_amount": 375, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 354.6, "standard_charge_percentage": 30.0000, "estimated_amount": 354, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 463.2, "estimated_amount": 463, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 237.55, "estimated_amount": 237, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 258.86, "standard_charge_percentage": 21.9000, "estimated_amount": 258, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 401.88, "standard_charge_percentage": 34.0000, "estimated_amount": 401, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 969.24, "standard_charge_percentage": 82.0000, "estimated_amount": 969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 300.06, "estimated_amount": 300, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 945.6, "standard_charge_percentage": 80.0000, "estimated_amount": 945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 768.3, "standard_charge_percentage": 65.0000, "estimated_amount": 768, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 337.57, "estimated_amount": 337, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 287.56, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" }]}]} , { "description": "Drain thigh/knee lesion", "code_information": [ { "code": "27301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6988, "discounted_cash": 3878,"minimum": 558,"maximum": 6804.65,"payers_information":[{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5800.04, "standard_charge_percentage": 83.0000, "estimated_amount": 5800, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1530.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4891.6, "standard_charge_percentage": 70.0000, "estimated_amount": 4891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1921.7, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2375.92, "standard_charge_percentage": 34.0000, "estimated_amount": 2375, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1823.87, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 717.56, "estimated_amount": 717, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4542.2, "standard_charge_percentage": 65.0000, "estimated_amount": 4542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 5403.43, "estimated_amount": 5403, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1530.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4961.48, "standard_charge_percentage": 71.0000, "estimated_amount": 4961, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1530.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 717.56, "estimated_amount": 717, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2096.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2096, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5133.26, "estimated_amount": 5133, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1397.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1397, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5025.19, "estimated_amount": 5025, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5241, "standard_charge_percentage": 75.0000, "estimated_amount": 5241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" }]}]} , { "description": "Exc thighknee les sc < 3 cm", "code_information": [ { "code": "27327", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1249.5, "discounted_cash": 2195,"minimum": 249.9,"maximum": 1249.5,"payers_information":[{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 937.13, "standard_charge_percentage": 75.0000, "estimated_amount": 937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 520.01, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 999.6, "standard_charge_percentage": 80.0000, "estimated_amount": 999, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 887.14, "standard_charge_percentage": 71.0000, "estimated_amount": 887, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 273.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 273, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "case rate" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 812.17, "standard_charge_percentage": 65.0000, "estimated_amount": 812, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 249.9, "standard_charge_percentage": 20.0000, "estimated_amount": 249, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 999.6, "standard_charge_percentage": 80.0000, "estimated_amount": 999, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 273.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 273, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 999.6, "standard_charge_percentage": 80.0000, "estimated_amount": 999, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 874.65, "standard_charge_percentage": 70.0000, "estimated_amount": 874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 273.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 273, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 424.83, "standard_charge_percentage": 34.0000, "estimated_amount": 424, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 520.01, "estimated_amount": 520, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 343.61, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 343, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 1037.09, "standard_charge_percentage": 83.0000, "estimated_amount": 1037, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 326.12, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 326, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 999.6, "standard_charge_percentage": 80.0000, "estimated_amount": 999, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 374.85, "standard_charge_percentage": 30.0000, "estimated_amount": 374, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 999.6, "standard_charge_percentage": 80.0000, "estimated_amount": 999, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1249.5, "estimated_amount": 1249, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8848, "discounted_cash": 3878,"minimum": 466.91,"maximum": 7343.84,"payers_information":[{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4377.64, "standard_charge_percentage": 53.2000, "estimated_amount": 4377, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2433.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1467, "estimated_amount": 1467, "methodology": "case rate" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2831.36, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2831, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7078.4, "standard_charge_percentage": 80.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4707.14, "standard_charge_percentage": 53.2000, "estimated_amount": 4707, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 7078.4, "standard_charge_percentage": 80.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1937.71, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6193.6, "standard_charge_percentage": 70.0000, "estimated_amount": 6193, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 466.91, "estimated_amount": 466, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7078.4, "standard_charge_percentage": 80.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3008.32, "standard_charge_percentage": 34.0000, "estimated_amount": 3008, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 7078.4, "standard_charge_percentage": 80.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 466.91, "estimated_amount": 466, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5751.2, "standard_charge_percentage": 65.0000, "estimated_amount": 5751, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6282.08, "standard_charge_percentage": 71.0000, "estimated_amount": 6282, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1937.71, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2654.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2654, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4471.78, "standard_charge_percentage": 53.2000, "estimated_amount": 4471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7343.84, "standard_charge_percentage": 83.0000, "estimated_amount": 7343, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6636, "standard_charge_percentage": 75.0000, "estimated_amount": 6636, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2309.33, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1937.71, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 7078.4, "standard_charge_percentage": 80.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1769.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1769, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" }]}]} , { "description": "Removal of kneecap bursa", "code_information": [ { "code": "27340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17118, "discounted_cash": 4396,"minimum": 410.95,"maximum": 14207.9,"payers_information":[{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 410.95, "estimated_amount": 410, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3748.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3748, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6441.01, "estimated_amount": 6441, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 11126.7, "standard_charge_percentage": 65.0000, "estimated_amount": 11126, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 14207.9, "standard_charge_percentage": 83.0000, "estimated_amount": 14207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6118.96, "estimated_amount": 6118, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4707.45, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4707, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 410.95, "estimated_amount": 410, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3423.6, "standard_charge_percentage": 20.0000, "estimated_amount": 3423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3748.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3748, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5990.14, "estimated_amount": 5990, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 12838.5, "standard_charge_percentage": 75.0000, "estimated_amount": 12838, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5135.4, "standard_charge_percentage": 30.0000, "estimated_amount": 5135, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4467.8, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4467, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3748.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3748, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 11982.6, "standard_charge_percentage": 70.0000, "estimated_amount": 11982, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 12153.8, "standard_charge_percentage": 71.0000, "estimated_amount": 12153, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5820.12, "standard_charge_percentage": 34.0000, "estimated_amount": 5820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" }]}]} , { "description": "Remove knee cyst", "code_information": [ { "code": "27347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6988, "discounted_cash": 4396,"minimum": 579.34,"maximum": 6988,"payers_information":[{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5241, "standard_charge_percentage": 75.0000, "estimated_amount": 5241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5990.14, "estimated_amount": 5990, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6988, "estimated_amount": 6988, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2375.92, "standard_charge_percentage": 34.0000, "estimated_amount": 2375, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4961.48, "standard_charge_percentage": 71.0000, "estimated_amount": 4961, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1530.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6441.01, "estimated_amount": 6441, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 579.34, "estimated_amount": 579, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1530.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1530, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1530.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1530, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5800.04, "standard_charge_percentage": 83.0000, "estimated_amount": 5800, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1823.87, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4542.2, "standard_charge_percentage": 65.0000, "estimated_amount": 4542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2096.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2096, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1921.7, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1921, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1397.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1397, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4891.6, "standard_charge_percentage": 70.0000, "estimated_amount": 4891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6118.96, "estimated_amount": 6118, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 579.34, "estimated_amount": 579, "methodology": "fee schedule" }]}]} , { "description": "Partial removal leg bone(s)", "code_information": [ { "code": "27360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13748.3, "discounted_cash": 4396,"minimum": 785,"maximum": 11411.1,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 5150, "estimated_amount": 5150, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10998.7, "standard_charge_percentage": 80.0000, "estimated_amount": 10998, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3010.88, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 7755.38, "estimated_amount": 7755, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7367.61, "estimated_amount": 7367, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 978.05, "estimated_amount": 978, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8936.41, "standard_charge_percentage": 65.0000, "estimated_amount": 8936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4124.5, "standard_charge_percentage": 30.0000, "estimated_amount": 4124, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 785, "estimated_amount": 785, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10998.7, "standard_charge_percentage": 80.0000, "estimated_amount": 10998, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9761.31, "standard_charge_percentage": 71.0000, "estimated_amount": 9761, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10998.7, "standard_charge_percentage": 80.0000, "estimated_amount": 10998, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3780.79, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3780, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 978.05, "estimated_amount": 978, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3010.88, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3010, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 11411.1, "standard_charge_percentage": 83.0000, "estimated_amount": 11411, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10998.7, "standard_charge_percentage": 80.0000, "estimated_amount": 10998, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3588.31, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3588, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9623.83, "standard_charge_percentage": 70.0000, "estimated_amount": 9623, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3010.88, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3010, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 10311.3, "standard_charge_percentage": 75.0000, "estimated_amount": 10311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4674.43, "standard_charge_percentage": 34.0000, "estimated_amount": 4674, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2749.67, "standard_charge_percentage": 20.0000, "estimated_amount": 2749, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10998.7, "standard_charge_percentage": 80.0000, "estimated_amount": 10998, "methodology": "percent of total billed charges" }]}]} , { "description": "Repair of kneecap tendon", "code_information": [ { "code": "27380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16228, "discounted_cash": 9680,"minimum": 365,"maximum": 16228,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 11359.6, "standard_charge_percentage": 70.0000, "estimated_amount": 11359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4868.4, "standard_charge_percentage": 30.0000, "estimated_amount": 4868, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3245.6, "standard_charge_percentage": 20.0000, "estimated_amount": 3245, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12982.4, "standard_charge_percentage": 80.0000, "estimated_amount": 12982, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1442, "estimated_amount": 1442, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3553.93, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3553, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6118.96, "estimated_amount": 6118, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6441.01, "estimated_amount": 6441, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 673.83, "estimated_amount": 673, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 12171, "standard_charge_percentage": 75.0000, "estimated_amount": 12171, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 12982.4, "standard_charge_percentage": 80.0000, "estimated_amount": 12982, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5990.14, "estimated_amount": 5990, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4235.51, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4235, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 11521.9, "standard_charge_percentage": 71.0000, "estimated_amount": 11521, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 10548.2, "standard_charge_percentage": 65.0000, "estimated_amount": 10548, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16228, "estimated_amount": 16228, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3553.93, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3553, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4462.7, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4462, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 673.83, "estimated_amount": 673, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3553.93, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3553, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12982.4, "standard_charge_percentage": 80.0000, "estimated_amount": 12982, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5517.52, "standard_charge_percentage": 34.0000, "estimated_amount": 5517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 12982.4, "standard_charge_percentage": 80.0000, "estimated_amount": 12982, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 13469.2, "standard_charge_percentage": 83.0000, "estimated_amount": 13469, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 12982.4, "standard_charge_percentage": 80.0000, "estimated_amount": 12982, "methodology": "percent of total billed charges" }]}]} , { "description": "Repair of thigh muscle", "code_information": [ { "code": "27385", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18976.5, "discounted_cash": 9680,"minimum": 558,"maximum": 16984.6,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4952.87, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4952, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6441.01, "estimated_amount": 6441, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 655.66, "estimated_amount": 655, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3795.3, "standard_charge_percentage": 20.0000, "estimated_amount": 3795, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15181.2, "standard_charge_percentage": 80.0000, "estimated_amount": 15181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 13473.3, "standard_charge_percentage": 71.0000, "estimated_amount": 13473, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 655.66, "estimated_amount": 655, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5692.95, "standard_charge_percentage": 30.0000, "estimated_amount": 5692, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 5218.54, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 5218, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 4155.85, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 4155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 5220.4, "estimated_amount": 5220, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 15181.2, "standard_charge_percentage": 80.0000, "estimated_amount": 15181, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 15181.2, "standard_charge_percentage": 80.0000, "estimated_amount": 15181, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6118.96, "estimated_amount": 6118, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 13283.5, "standard_charge_percentage": 70.0000, "estimated_amount": 13283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 5220.4, "estimated_amount": 5220, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 4155.85, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 4155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 5481.42, "estimated_amount": 5481, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5990.14, "estimated_amount": 5990, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 5220.4, "estimated_amount": 5220, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 5481.42, "estimated_amount": 5481, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 6452.01, "standard_charge_percentage": 34.0000, "estimated_amount": 6452, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 15750.5, "standard_charge_percentage": 83.0000, "estimated_amount": 15750, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5220.4, "estimated_amount": 5220, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 12334.7, "standard_charge_percentage": 65.0000, "estimated_amount": 12334, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 4155.85, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 4155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 15181.2, "standard_charge_percentage": 80.0000, "estimated_amount": 15181, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15181.2, "standard_charge_percentage": 80.0000, "estimated_amount": 15181, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 5220.4, "estimated_amount": 5220, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 5220.4, "estimated_amount": 5220, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 14232.4, "standard_charge_percentage": 75.0000, "estimated_amount": 14232, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" }]}]} , { "description": "Revise kneecap with implant", "code_information": [ { "code": "27438", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36581, "discounted_cash": 17436,"minimum": 785,"maximum": 30591.5,"payers_information":[{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 27435.8, "standard_charge_percentage": 75.0000, "estimated_amount": 27435, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 13908, "estimated_amount": 13908, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 5150, "estimated_amount": 5150, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 18107, "estimated_amount": 18107, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 12510.1, "estimated_amount": 12510, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 29264.8, "standard_charge_percentage": 80.0000, "estimated_amount": 29264, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 12510.1, "estimated_amount": 12510, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 18777.7, "estimated_amount": 18777, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 29264.8, "standard_charge_percentage": 80.0000, "estimated_amount": 29264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 922.19, "estimated_amount": 922, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 14640, "estimated_amount": 14640, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 13615.2, "estimated_amount": 13615, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 30591.5, "estimated_amount": 30591, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 25606.7, "standard_charge_percentage": 70.0000, "estimated_amount": 25606, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 30362.2, "standard_charge_percentage": 83.0000, "estimated_amount": 30362, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 16095.2, "estimated_amount": 16095, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 785, "estimated_amount": 785, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 20118.9, "estimated_amount": 20118, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 16765.8, "estimated_amount": 16765, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 12437.5, "standard_charge_percentage": 34.0000, "estimated_amount": 12437, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 15424.5, "estimated_amount": 15424, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 7316.2, "standard_charge_percentage": 20.0000, "estimated_amount": 7316, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 29264.8, "standard_charge_percentage": 80.0000, "estimated_amount": 29264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 922.19, "estimated_amount": 922, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 21728.5, "estimated_amount": 21728, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10974.3, "standard_charge_percentage": 30.0000, "estimated_amount": 10974, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 13144.4, "estimated_amount": 13144, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 14753.9, "estimated_amount": 14753, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 25972.5, "standard_charge_percentage": 71.0000, "estimated_amount": 25972, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 29264.8, "standard_charge_percentage": 80.0000, "estimated_amount": 29264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 23777.7, "standard_charge_percentage": 65.0000, "estimated_amount": 23777, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 29264.8, "standard_charge_percentage": 80.0000, "estimated_amount": 29264, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8889, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 12742, "estimated_amount": 12742, "methodology": "fee schedule" }]}]} , { "description": "Revision Of Knee Joint", "code_information": [ { "code": "27446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36555, "discounted_cash": 17436,"minimum": 1256.68,"maximum": 36555,"payers_information":[{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 9138.75, "standard_charge_percentage": 25.0000, "estimated_amount": 9138, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 36555, "estimated_amount": 36555, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 16765.8, "estimated_amount": 16765, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 29244, "standard_charge_percentage": 80.0000, "estimated_amount": 29244, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 9528, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 9528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 15424.5, "estimated_amount": 15424, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 27416.3, "standard_charge_percentage": 75.0000, "estimated_amount": 27416, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 12510.1, "estimated_amount": 12510, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1256.68, "estimated_amount": 1256, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 12510.1, "estimated_amount": 12510, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8889, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10966.5, "standard_charge_percentage": 30.0000, "estimated_amount": 10966, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 12428.7, "standard_charge_percentage": 34.0000, "estimated_amount": 12428, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 7311, "standard_charge_percentage": 20.0000, "estimated_amount": 7311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 13144.4, "estimated_amount": 13144, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 21728.5, "estimated_amount": 21728, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 14753.9, "estimated_amount": 14753, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 12742, "estimated_amount": 12742, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 16095.2, "estimated_amount": 16095, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 30591.5, "estimated_amount": 30591, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 18107, "estimated_amount": 18107, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 25954, "standard_charge_percentage": 71.0000, "estimated_amount": 25954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 23760.8, "standard_charge_percentage": 65.0000, "estimated_amount": 23760, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 18777.7, "estimated_amount": 18777, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 20118.9, "estimated_amount": 20118, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 36555, "estimated_amount": 36555, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 30340.7, "standard_charge_percentage": 83.0000, "estimated_amount": 30340, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 29244, "standard_charge_percentage": 80.0000, "estimated_amount": 29244, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 25588.5, "standard_charge_percentage": 70.0000, "estimated_amount": 25588, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 29244, "standard_charge_percentage": 80.0000, "estimated_amount": 29244, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1256.68, "estimated_amount": 1256, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 29244, "standard_charge_percentage": 80.0000, "estimated_amount": 29244, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 36555, "estimated_amount": 36555, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 29244, "standard_charge_percentage": 80.0000, "estimated_amount": 29244, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" }]}]} , { "description": "Total knee arthroplasty", "code_information": [ { "code": "27447", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40674, "discounted_cash": 17436,"minimum": 1404.51,"maximum": 33759.4,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 30591.5, "estimated_amount": 30591, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 16095.2, "estimated_amount": 16095, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 26438.1, "standard_charge_percentage": 65.0000, "estimated_amount": 26438, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 32539.2, "standard_charge_percentage": 80.0000, "estimated_amount": 32539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 10168.5, "standard_charge_percentage": 25.0000, "estimated_amount": 10168, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 21638.6, "standard_charge_percentage": 53.2000, "estimated_amount": 21638, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 18107, "estimated_amount": 18107, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 28471.8, "standard_charge_percentage": 70.0000, "estimated_amount": 28471, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 12510.1, "estimated_amount": 12510, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32539.2, "standard_charge_percentage": 80.0000, "estimated_amount": 32539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 9528, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 9528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 18777.7, "estimated_amount": 18777, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 20556.6, "standard_charge_percentage": 53.2000, "estimated_amount": 20556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32539.2, "standard_charge_percentage": 80.0000, "estimated_amount": 32539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2846, "estimated_amount": 2846, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 32539.2, "standard_charge_percentage": 80.0000, "estimated_amount": 32539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 8134.8, "standard_charge_percentage": 20.0000, "estimated_amount": 8134, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 20123.9, "standard_charge_percentage": 53.2000, "estimated_amount": 20123, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 20118.9, "estimated_amount": 20118, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 13144.4, "estimated_amount": 13144, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 12510.1, "estimated_amount": 12510, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 33759.4, "standard_charge_percentage": 83.0000, "estimated_amount": 33759, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8889, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 15424.5, "estimated_amount": 15424, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 30505.5, "standard_charge_percentage": 75.0000, "estimated_amount": 30505, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 14753.9, "estimated_amount": 14753, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12202.2, "standard_charge_percentage": 30.0000, "estimated_amount": 12202, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1404.51, "estimated_amount": 1404, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 12742, "estimated_amount": 12742, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 21728.5, "estimated_amount": 21728, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 16765.8, "estimated_amount": 16765, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 13829.2, "standard_charge_percentage": 34.0000, "estimated_amount": 13829, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 28878.5, "standard_charge_percentage": 71.0000, "estimated_amount": 28878, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1404.51, "estimated_amount": 1404, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 32539.2, "standard_charge_percentage": 80.0000, "estimated_amount": 32539, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" }]}]} , { "description": "Revise/Replace Knee Joint", "code_information": [ { "code": "27487", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61965,"minimum": 1917.42,"maximum": 51430.9,"payers_information":[{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 15491.3, "standard_charge_percentage": 25.0000, "estimated_amount": 15491, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 49572, "standard_charge_percentage": 80.0000, "estimated_amount": 49572, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 49572, "standard_charge_percentage": 80.0000, "estimated_amount": 49572, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 43995.2, "standard_charge_percentage": 71.0000, "estimated_amount": 43995, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 46473.8, "standard_charge_percentage": 75.0000, "estimated_amount": 46473, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 40277.3, "standard_charge_percentage": 65.0000, "estimated_amount": 40277, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 12510.1, "estimated_amount": 12510, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 49572, "standard_charge_percentage": 80.0000, "estimated_amount": 49572, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 31317.1, "standard_charge_percentage": 53.2000, "estimated_amount": 31317, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 9528, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 9528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1917.42, "estimated_amount": 1917, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 18589.5, "standard_charge_percentage": 30.0000, "estimated_amount": 18589, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 49572, "standard_charge_percentage": 80.0000, "estimated_amount": 49572, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8889, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2846, "estimated_amount": 2846, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 14049.2, "estimated_amount": 14049, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1917.42, "estimated_amount": 1917, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 49572, "standard_charge_percentage": 80.0000, "estimated_amount": 49572, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 21068.1, "standard_charge_percentage": 34.0000, "estimated_amount": 21068, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 30657.8, "standard_charge_percentage": 53.2000, "estimated_amount": 30657, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 43375.5, "standard_charge_percentage": 70.0000, "estimated_amount": 43375, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 11914.4, "estimated_amount": 11914, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 32965.4, "standard_charge_percentage": 53.2000, "estimated_amount": 32965, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 12510.1, "estimated_amount": 12510, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 14049.2, "estimated_amount": 14049, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 51430.9, "standard_charge_percentage": 83.0000, "estimated_amount": 51430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 12393, "standard_charge_percentage": 20.0000, "estimated_amount": 12393, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" }]}]} , { "description": "Treatment of thigh fracture", "code_information": [ { "code": "27502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4366, "discounted_cash": 2168,"minimum": 483.81,"maximum": 3805.04,"payers_information":[{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1309.8, "standard_charge_percentage": 30.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1139.53, "standard_charge_percentage": 26.1000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1484.44, "standard_charge_percentage": 34.0000, "estimated_amount": 1484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3580.12, "standard_charge_percentage": 82.0000, "estimated_amount": 3580, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3099.86, "standard_charge_percentage": 71.0000, "estimated_amount": 3099, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3623.78, "standard_charge_percentage": 83.0000, "estimated_amount": 3623, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 831.18, "estimated_amount": 831, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2837.9, "standard_charge_percentage": 65.0000, "estimated_amount": 2837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1200.65, "standard_charge_percentage": 27.5000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3056.2, "standard_charge_percentage": 70.0000, "estimated_amount": 3056, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3274.5, "standard_charge_percentage": 75.0000, "estimated_amount": 3274, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 873.2, "standard_charge_percentage": 20.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 831.18, "estimated_amount": 831, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" }]}]} , { "description": "Treat kneecap fracture", "code_information": [ { "code": "27524", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31531, "discounted_cash": 9680,"minimum": 558,"maximum": 26170.7,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 11584.9, "estimated_amount": 11584, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9459.3, "standard_charge_percentage": 30.0000, "estimated_amount": 9459, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 826.28, "estimated_amount": 826, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 22387, "standard_charge_percentage": 71.0000, "estimated_amount": 22387, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 10720.5, "standard_charge_percentage": 34.0000, "estimated_amount": 10720, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 6306.2, "standard_charge_percentage": 20.0000, "estimated_amount": 6306, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 23648.3, "standard_charge_percentage": 75.0000, "estimated_amount": 23648, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 25224.8, "standard_charge_percentage": 80.0000, "estimated_amount": 25224, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 10774, "estimated_amount": 10773, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 25224.8, "standard_charge_percentage": 80.0000, "estimated_amount": 25224, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 22071.7, "standard_charge_percentage": 70.0000, "estimated_amount": 22071, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 9528, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 9528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 25224.8, "standard_charge_percentage": 80.0000, "estimated_amount": 25224, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11005.7, "estimated_amount": 11005, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 20495.2, "standard_charge_percentage": 65.0000, "estimated_amount": 20495, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8671.02, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8671, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 826.28, "estimated_amount": 826, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 26170.7, "standard_charge_percentage": 83.0000, "estimated_amount": 26170, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 25224.8, "standard_charge_percentage": 80.0000, "estimated_amount": 25224, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 25224.8, "standard_charge_percentage": 80.0000, "estimated_amount": 25224, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" }]}]} , { "description": "Treat knee fracture", "code_information": [ { "code": "27535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21686,"minimum": 982.31,"maximum": 17999.4,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 15397.1, "standard_charge_percentage": 71.0000, "estimated_amount": 15397, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 4749.23, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 4749, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 4749.23, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 4749, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 17999.4, "standard_charge_percentage": 83.0000, "estimated_amount": 17999, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 17348.8, "standard_charge_percentage": 80.0000, "estimated_amount": 17348, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 6939.52, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 6939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 10960.1, "standard_charge_percentage": 53.2000, "estimated_amount": 10960, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 14095.9, "standard_charge_percentage": 65.0000, "estimated_amount": 14095, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 11537, "standard_charge_percentage": 53.2000, "estimated_amount": 11536, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 1433.3, "estimated_amount": 1433, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 17348.8, "standard_charge_percentage": 80.0000, "estimated_amount": 17348, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 5963.65, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 5963, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 17348.8, "standard_charge_percentage": 80.0000, "estimated_amount": 17348, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 982.31, "estimated_amount": 982, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 10729.4, "standard_charge_percentage": 53.2000, "estimated_amount": 10729, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 7373.24, "standard_charge_percentage": 34.0000, "estimated_amount": 7373, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 5421.5, "standard_charge_percentage": 25.0000, "estimated_amount": 5421, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 4337.2, "standard_charge_percentage": 20.0000, "estimated_amount": 4337, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 15180.2, "standard_charge_percentage": 70.0000, "estimated_amount": 15180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 982.31, "estimated_amount": 982, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 16264.5, "standard_charge_percentage": 75.0000, "estimated_amount": 16264, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1433.3, "estimated_amount": 1433, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 4749.23, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 4749, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5660.05, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5660, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 17348.8, "standard_charge_percentage": 80.0000, "estimated_amount": 17348, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 17348.8, "standard_charge_percentage": 80.0000, "estimated_amount": 17348, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6505.8, "standard_charge_percentage": 30.0000, "estimated_amount": 6505, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" }]}]} , { "description": "Treat knee fracture", "code_information": [ { "code": "27536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43574,"minimum": 1299.85,"maximum": 36166.4,"payers_information":[{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1299.85, "estimated_amount": 1299, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 13072.2, "standard_charge_percentage": 30.0000, "estimated_amount": 13072, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 34859.2, "standard_charge_percentage": 80.0000, "estimated_amount": 34859, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 14815.2, "standard_charge_percentage": 34.0000, "estimated_amount": 14815, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 22022.3, "standard_charge_percentage": 53.2000, "estimated_amount": 22022, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 34859.2, "standard_charge_percentage": 80.0000, "estimated_amount": 34859, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 34859.2, "standard_charge_percentage": 80.0000, "estimated_amount": 34859, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 32680.5, "standard_charge_percentage": 75.0000, "estimated_amount": 32680, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 34859.2, "standard_charge_percentage": 80.0000, "estimated_amount": 34859, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 28323.1, "standard_charge_percentage": 65.0000, "estimated_amount": 28323, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 8714.8, "standard_charge_percentage": 20.0000, "estimated_amount": 8714, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 23181.4, "standard_charge_percentage": 53.2000, "estimated_amount": 23181, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1299.85, "estimated_amount": 1299, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 10893.5, "standard_charge_percentage": 25.0000, "estimated_amount": 10893, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 21558.7, "standard_charge_percentage": 53.2000, "estimated_amount": 21558, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4820.2, "estimated_amount": 4820, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 9528, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 9528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 30937.5, "standard_charge_percentage": 71.0000, "estimated_amount": 30937, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8889, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8889, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 4820.2, "estimated_amount": 4820, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 34859.2, "standard_charge_percentage": 80.0000, "estimated_amount": 34859, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 36166.4, "standard_charge_percentage": 83.0000, "estimated_amount": 36166, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 30501.8, "standard_charge_percentage": 70.0000, "estimated_amount": 30501, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Patellr Disloc Wo Anes", "code_information": [ { "code": "27560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 695, "discounted_cash": 325,"minimum": 139,"maximum": 695,"payers_information":[{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 569.9, "standard_charge_percentage": 82.0000, "estimated_amount": 569, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 695, "estimated_amount": 695, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 300.06, "estimated_amount": 300, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 451.75, "standard_charge_percentage": 65.0000, "estimated_amount": 451, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 237.55, "estimated_amount": 237, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 521.25, "standard_charge_percentage": 75.0000, "estimated_amount": 521, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 405.08, "estimated_amount": 405, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 570.31, "estimated_amount": 570, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 486.5, "standard_charge_percentage": 70.0000, "estimated_amount": 486, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 337.57, "estimated_amount": 337, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 412.81, "estimated_amount": 412, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 275.06, "estimated_amount": 275, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 236.3, "standard_charge_percentage": 34.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 287.56, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 139, "standard_charge_percentage": 20.0000, "estimated_amount": 139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 412.81, "estimated_amount": 412, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 576.85, "standard_charge_percentage": 83.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 208.5, "standard_charge_percentage": 30.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 375.07, "estimated_amount": 375, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 312.56, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 245.05, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 350.07, "estimated_amount": 350, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 181.4, "standard_charge_percentage": 26.1000, "estimated_amount": 181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 191.13, "standard_charge_percentage": 27.5000, "estimated_amount": 191, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 493.45, "standard_charge_percentage": 71.0000, "estimated_amount": 493, "methodology": "percent of total billed charges" }]}]} , { "description": "Fixation Of Knee Joint", "code_information": [ { "code": "27570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4123, "discounted_cash": 2168,"minimum": 169.15,"maximum": 4123,"payers_information":[{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3298.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3298, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3298.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3298, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2886.1, "standard_charge_percentage": 70.0000, "estimated_amount": 2886, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3422.09, "standard_charge_percentage": 83.0000, "estimated_amount": 3422, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4123, "estimated_amount": 4123, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1401.82, "standard_charge_percentage": 34.0000, "estimated_amount": 1401, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4123, "estimated_amount": 4123, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 824.6, "standard_charge_percentage": 20.0000, "estimated_amount": 824, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3298.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3298, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2927.33, "standard_charge_percentage": 71.0000, "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1272.63, "estimated_amount": 1272, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4123, "estimated_amount": 4123, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 169.15, "estimated_amount": 169, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 902.94, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1272.63, "estimated_amount": 1272, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1442, "estimated_amount": 1442, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 902.94, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3298.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3298, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4123, "estimated_amount": 4123, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3298.4, "standard_charge_percentage": 80.0000, "estimated_amount": 3298, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1076.1, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1076, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1133.83, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1133, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1236.9, "standard_charge_percentage": 30.0000, "estimated_amount": 1236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 169.15, "estimated_amount": 169, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 902.94, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 902, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2679.95, "standard_charge_percentage": 65.0000, "estimated_amount": 2679, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3092.25, "standard_charge_percentage": 75.0000, "estimated_amount": 3092, "methodology": "percent of total billed charges" }]}]} , { "description": "Unlisted px femurknee", "code_information": [ { "code": "27599", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4072, "discounted_cash": 325,"minimum": 237.55,"maximum": 4072,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 350.07, "estimated_amount": 350, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 570.31, "estimated_amount": 570, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 275.06, "estimated_amount": 275, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2850.4, "standard_charge_percentage": 70.0000, "estimated_amount": 2850, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 337.57, "estimated_amount": 337, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3257.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3257, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 891.77, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 891, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1062.79, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1062, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4072, "estimated_amount": 4072, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1384.48, "standard_charge_percentage": 34.0000, "estimated_amount": 1384, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2646.8, "standard_charge_percentage": 65.0000, "estimated_amount": 2646, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1018, "standard_charge_percentage": 25.0000, "estimated_amount": 1018, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3257.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3257, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3379.76, "standard_charge_percentage": 83.0000, "estimated_amount": 3379, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 814.4, "standard_charge_percentage": 20.0000, "estimated_amount": 814, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 312.56, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 237.55, "estimated_amount": 237, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 405.08, "estimated_amount": 405, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 245.05, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 891.77, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3257.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3257, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3054, "standard_charge_percentage": 75.0000, "estimated_amount": 3054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3257.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3257, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2891.12, "standard_charge_percentage": 71.0000, "estimated_amount": 2891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1119.8, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1119, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3257.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3257, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1221.6, "standard_charge_percentage": 30.0000, "estimated_amount": 1221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 375.07, "estimated_amount": 375, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 287.56, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1303.04, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 1303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1221.6, "standard_charge_percentage": 30.0000, "estimated_amount": 1221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 300.06, "estimated_amount": 300, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 891.77, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 891, "methodology": "percent of total billed charges" }]}]} , { "description": "Drain lower leg lesion", "code_information": [ { "code": "27603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2949.33, "discounted_cash": 3878,"minimum": 488,"maximum": 2949.33,"payers_information":[{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 884.8, "standard_charge_percentage": 30.0000, "estimated_amount": 884, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1917.06, "standard_charge_percentage": 65.0000, "estimated_amount": 1917, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 645.9, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 645, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 2447.94, "standard_charge_percentage": 83.0000, "estimated_amount": 2447, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2359.46, "standard_charge_percentage": 80.0000, "estimated_amount": 2359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 769.78, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 769, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 2094.02, "standard_charge_percentage": 71.0000, "estimated_amount": 2094, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 645.9, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 645, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2064.53, "standard_charge_percentage": 70.0000, "estimated_amount": 2064, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 589.87, "standard_charge_percentage": 20.0000, "estimated_amount": 589, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 2212, "standard_charge_percentage": 75.0000, "estimated_amount": 2212, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1002.77, "standard_charge_percentage": 34.0000, "estimated_amount": 1002, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 2359.46, "standard_charge_percentage": 80.0000, "estimated_amount": 2359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 2359.46, "standard_charge_percentage": 80.0000, "estimated_amount": 2359, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 545.13, "estimated_amount": 545, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 811.07, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 811, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 2359.46, "standard_charge_percentage": 80.0000, "estimated_amount": 2359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 545.13, "estimated_amount": 545, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 645.9, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 645, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2359.46, "standard_charge_percentage": 80.0000, "estimated_amount": 2359, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2949.33, "estimated_amount": 2949, "methodology": "case rate" }]}]} , { "description": "Exc leg/ankle tum < 3 cm", "code_information": [ { "code": "27618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8240, "discounted_cash": 2195,"minimum": 488,"maximum": 6839.2,"payers_information":[{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5768, "standard_charge_percentage": 70.0000, "estimated_amount": 5768, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4427.78, "estimated_amount": 4427, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4660.82, "estimated_amount": 4660, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2472, "standard_charge_percentage": 30.0000, "estimated_amount": 2472, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1804.56, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1804, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 5850.4, "standard_charge_percentage": 71.0000, "estimated_amount": 5850, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 503.54, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1648, "standard_charge_percentage": 20.0000, "estimated_amount": 1648, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2801.6, "standard_charge_percentage": 34.0000, "estimated_amount": 2801, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6592, "standard_charge_percentage": 80.0000, "estimated_amount": 6592, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1804.56, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1804, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6592, "standard_charge_percentage": 80.0000, "estimated_amount": 6592, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 6839.2, "standard_charge_percentage": 83.0000, "estimated_amount": 6839, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6592, "standard_charge_percentage": 80.0000, "estimated_amount": 6592, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 503.54, "estimated_amount": 503, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5356, "standard_charge_percentage": 65.0000, "estimated_amount": 5356, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1804.56, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1804, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2266, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2266, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6592, "standard_charge_percentage": 80.0000, "estimated_amount": 6592, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2150.64, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2150, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6592, "standard_charge_percentage": 80.0000, "estimated_amount": 6592, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4334.56, "estimated_amount": 4334, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6180, "standard_charge_percentage": 75.0000, "estimated_amount": 6180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" }]}]} , { "description": "Removal of tendon lesion", "code_information": [ { "code": "27630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7838.5, "discounted_cash": 4396,"minimum": 558,"maximum": 7714.21,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 559.01, "estimated_amount": 559, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5878.88, "standard_charge_percentage": 75.0000, "estimated_amount": 5878, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1716.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1716, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6270.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6270, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6441.01, "estimated_amount": 6441, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6270.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6270, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 6505.95, "standard_charge_percentage": 83.0000, "estimated_amount": 6505, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1567.7, "standard_charge_percentage": 20.0000, "estimated_amount": 1567, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2665.09, "standard_charge_percentage": 34.0000, "estimated_amount": 2665, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1716.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1716, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5990.14, "estimated_amount": 5990, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5486.95, "standard_charge_percentage": 70.0000, "estimated_amount": 5486, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2045.85, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2045, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6118.96, "estimated_amount": 6118, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6270.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6270, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6270.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6270, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2155.59, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2155, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1716.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1716, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6270.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6270, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 559.01, "estimated_amount": 559, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2351.55, "standard_charge_percentage": 30.0000, "estimated_amount": 2351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 5565.34, "standard_charge_percentage": 71.0000, "estimated_amount": 5565, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5095.02, "standard_charge_percentage": 65.0000, "estimated_amount": 5095, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6025, "discounted_cash": 4396,"minimum": 558,"maximum": 6025,"payers_information":[{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5000.75, "standard_charge_percentage": 83.0000, "estimated_amount": 5000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1807.5, "standard_charge_percentage": 30.0000, "estimated_amount": 1807, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6025, "estimated_amount": 6025, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6025, "estimated_amount": 6025, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6025, "estimated_amount": 6025, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4820, "standard_charge_percentage": 80.0000, "estimated_amount": 4820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4820, "standard_charge_percentage": 80.0000, "estimated_amount": 4820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1319.47, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1319, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4820, "standard_charge_percentage": 80.0000, "estimated_amount": 4820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4820, "standard_charge_percentage": 80.0000, "estimated_amount": 4820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4277.75, "standard_charge_percentage": 71.0000, "estimated_amount": 4277, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 624.97, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1656.88, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1656, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4518.75, "standard_charge_percentage": 75.0000, "estimated_amount": 4518, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1319.47, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1319, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4217.5, "standard_charge_percentage": 70.0000, "estimated_amount": 4217, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2048.5, "standard_charge_percentage": 34.0000, "estimated_amount": 2048, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3916.25, "standard_charge_percentage": 65.0000, "estimated_amount": 3916, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1205, "standard_charge_percentage": 20.0000, "estimated_amount": 1205, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 624.97, "estimated_amount": 624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1572.53, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1572, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1319.47, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1319, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4820, "standard_charge_percentage": 80.0000, "estimated_amount": 4820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 6025, "estimated_amount": 6025, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5919.66, "discounted_cash": 4396,"minimum": 488,"maximum": 5919.66,"payers_information":[{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4735.73, "standard_charge_percentage": 80.0000, "estimated_amount": 4735, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4143.76, "standard_charge_percentage": 70.0000, "estimated_amount": 4143, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 5919.66, "estimated_amount": 5919, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 5919.66, "estimated_amount": 5919, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 5919.66, "estimated_amount": 5919, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1183.93, "standard_charge_percentage": 20.0000, "estimated_amount": 1183, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1296.41, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1296, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1627.91, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1627, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 5919.66, "estimated_amount": 5919, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2012.68, "standard_charge_percentage": 34.0000, "estimated_amount": 2012, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1545.03, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1545, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1296.41, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1296, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4439.74, "standard_charge_percentage": 75.0000, "estimated_amount": 4439, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 5919.66, "estimated_amount": 5919, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 5919.66, "estimated_amount": 5919, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4735.73, "standard_charge_percentage": 80.0000, "estimated_amount": 4735, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 5919.66, "estimated_amount": 5919, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 896.75, "estimated_amount": 896, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4735.73, "standard_charge_percentage": 80.0000, "estimated_amount": 4735, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 896.75, "estimated_amount": 896, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1296.41, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3847.78, "standard_charge_percentage": 65.0000, "estimated_amount": 3847, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 5919.66, "estimated_amount": 5919, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4735.73, "standard_charge_percentage": 80.0000, "estimated_amount": 4735, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1775.9, "standard_charge_percentage": 30.0000, "estimated_amount": 1775, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 5919.66, "estimated_amount": 5919, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 5919.66, "estimated_amount": 5919, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4735.73, "standard_charge_percentage": 80.0000, "estimated_amount": 4735, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5919.66, "estimated_amount": 5919, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5919.66, "estimated_amount": 5919, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4202.96, "standard_charge_percentage": 71.0000, "estimated_amount": 4202, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 4913.32, "standard_charge_percentage": 83.0000, "estimated_amount": 4913, "methodology": "percent of total billed charges" }]}]} , { "description": "Repair Achilles Tendon", "code_information": [ { "code": "27650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18984, "discounted_cash": 9680,"minimum": 558,"maximum": 16984.6,"payers_information":[{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5695.2, "standard_charge_percentage": 30.0000, "estimated_amount": 5695, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 12680.8, "estimated_amount": 12680, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 15187.2, "standard_charge_percentage": 80.0000, "estimated_amount": 15187, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 15756.7, "standard_charge_percentage": 83.0000, "estimated_amount": 15756, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 15187.2, "standard_charge_percentage": 80.0000, "estimated_amount": 15187, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 11793.1, "estimated_amount": 11793, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 6454.56, "standard_charge_percentage": 34.0000, "estimated_amount": 6454, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 708.04, "estimated_amount": 708, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 4157.5, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 4157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 12339.6, "standard_charge_percentage": 65.0000, "estimated_amount": 12339, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 13288.8, "standard_charge_percentage": 70.0000, "estimated_amount": 13288, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 708.04, "estimated_amount": 708, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 12046.8, "estimated_amount": 12046, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3796.8, "standard_charge_percentage": 20.0000, "estimated_amount": 3796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 15187.2, "standard_charge_percentage": 80.0000, "estimated_amount": 15187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 14238, "standard_charge_percentage": 75.0000, "estimated_amount": 14238, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 4157.5, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 4157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 5220.6, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 5220, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 15187.2, "standard_charge_percentage": 80.0000, "estimated_amount": 15187, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 13478.6, "standard_charge_percentage": 71.0000, "estimated_amount": 13478, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 15187.2, "standard_charge_percentage": 80.0000, "estimated_amount": 15187, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 4157.5, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 4157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4954.82, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" }]}]} , { "description": "Repairgraft achilles tendon", "code_information": [ { "code": "27652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12901, "discounted_cash": 9680,"minimum": 558,"maximum": 12901,"payers_information":[{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10320.8, "standard_charge_percentage": 80.0000, "estimated_amount": 10320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 12901, "estimated_amount": 12901, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9159.71, "standard_charge_percentage": 71.0000, "estimated_amount": 9159, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2825.32, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9030.7, "standard_charge_percentage": 70.0000, "estimated_amount": 9030, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10707.8, "standard_charge_percentage": 83.0000, "estimated_amount": 10707, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 12901, "estimated_amount": 12901, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10320.8, "standard_charge_percentage": 80.0000, "estimated_amount": 10320, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9675.75, "standard_charge_percentage": 75.0000, "estimated_amount": 9675, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2825.32, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10320.8, "standard_charge_percentage": 80.0000, "estimated_amount": 10320, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3547.78, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3547, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2580.2, "standard_charge_percentage": 20.0000, "estimated_amount": 2580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 710.59, "estimated_amount": 710, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 9665.96, "estimated_amount": 9665, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10320.8, "standard_charge_percentage": 80.0000, "estimated_amount": 10320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 12901, "estimated_amount": 12901, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2825.32, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2825, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10320.8, "standard_charge_percentage": 80.0000, "estimated_amount": 10320, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 12901, "estimated_amount": 12901, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 9665.96, "estimated_amount": 9665, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 710.59, "estimated_amount": 710, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8385.65, "standard_charge_percentage": 65.0000, "estimated_amount": 8385, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3870.3, "standard_charge_percentage": 30.0000, "estimated_amount": 3870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3367.16, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3367, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4386.34, "standard_charge_percentage": 34.0000, "estimated_amount": 4386, "methodology": "percent of total billed charges" }]}]} , { "description": "Repair of achilles tendon", "code_information": [ { "code": "27654", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17768, "discounted_cash": 9680,"minimum": 558,"maximum": 16984.6,"payers_information":[{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 12680.8, "estimated_amount": 12680, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3891.19, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 6041.12, "standard_charge_percentage": 34.0000, "estimated_amount": 6041, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4886.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4886, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 12615.3, "standard_charge_percentage": 71.0000, "estimated_amount": 12615, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3891.19, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5330.4, "standard_charge_percentage": 30.0000, "estimated_amount": 5330, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 14214.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14214, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 14214.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14214, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 14747.4, "standard_charge_percentage": 83.0000, "estimated_amount": 14747, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14214.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14214, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 770.43, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 12046.8, "estimated_amount": 12046, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 770.43, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 11549.2, "standard_charge_percentage": 65.0000, "estimated_amount": 11549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3553.6, "standard_charge_percentage": 20.0000, "estimated_amount": 3553, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 13326, "standard_charge_percentage": 75.0000, "estimated_amount": 13326, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 14214.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14214, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14214.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14214, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3891.19, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3891, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4637.45, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4637, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 12437.6, "standard_charge_percentage": 70.0000, "estimated_amount": 12437, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 9665.96, "estimated_amount": 9665, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 9665.96, "estimated_amount": 9665, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 11793.1, "estimated_amount": 11793, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" }]}]} , { "description": "Repair of leg tendon each", "code_information": [ { "code": "27658", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8559, "discounted_cash": 4396,"minimum": 365,"maximum": 7714.21,"payers_information":[{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1874.42, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6847.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6847, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1711.8, "standard_charge_percentage": 20.0000, "estimated_amount": 1711, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6847.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6847, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6847.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6847, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2567.7, "standard_charge_percentage": 30.0000, "estimated_amount": 2567, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 397.41, "estimated_amount": 397, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1442, "estimated_amount": 1442, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6076.89, "standard_charge_percentage": 71.0000, "estimated_amount": 6076, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6419.25, "standard_charge_percentage": 75.0000, "estimated_amount": 6419, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6847.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6847, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6847.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6847, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2353.72, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2353, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5563.35, "standard_charge_percentage": 65.0000, "estimated_amount": 5563, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7103.97, "standard_charge_percentage": 83.0000, "estimated_amount": 7103, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6441.01, "estimated_amount": 6441, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2910.06, "standard_charge_percentage": 34.0000, "estimated_amount": 2910, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1874.42, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1874, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1874.42, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1874, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 397.41, "estimated_amount": 397, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 6118.96, "estimated_amount": 6118, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5990.14, "estimated_amount": 5990, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2233.9, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2233, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5991.3, "standard_charge_percentage": 70.0000, "estimated_amount": 5991, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" }]}]} , { "description": "Revision of lower leg tendon", "code_information": [ { "code": "27685", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32050.5, "discounted_cash": 4396,"minimum": 558,"maximum": 26601.9,"payers_information":[{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8813.89, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8813, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 25640.4, "standard_charge_percentage": 80.0000, "estimated_amount": 25640, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 22755.8, "standard_charge_percentage": 71.0000, "estimated_amount": 22755, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 10897.2, "standard_charge_percentage": 34.0000, "estimated_amount": 10897, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 25640.4, "standard_charge_percentage": 80.0000, "estimated_amount": 25640, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7367.61, "estimated_amount": 7367, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 20832.8, "standard_charge_percentage": 65.0000, "estimated_amount": 20832, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 25640.4, "standard_charge_percentage": 80.0000, "estimated_amount": 25640, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 9615.15, "standard_charge_percentage": 30.0000, "estimated_amount": 9615, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 25640.4, "standard_charge_percentage": 80.0000, "estimated_amount": 25640, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 22435.3, "standard_charge_percentage": 70.0000, "estimated_amount": 22435, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 678.72, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 25640.4, "standard_charge_percentage": 80.0000, "estimated_amount": 25640, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 6410.1, "standard_charge_percentage": 20.0000, "estimated_amount": 6410, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 678.72, "estimated_amount": 678, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 26601.9, "standard_charge_percentage": 83.0000, "estimated_amount": 26601, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 24037.9, "standard_charge_percentage": 75.0000, "estimated_amount": 24037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 7755.38, "estimated_amount": 7755, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" }]}]} , { "description": "Repair of ankle ligament", "code_information": [ { "code": "27695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20902, "discounted_cash": 9680,"minimum": 488,"maximum": 17348.7,"payers_information":[{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 4180.4, "standard_charge_percentage": 20.0000, "estimated_amount": 4180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 4577.54, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 4577, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 16721.6, "standard_charge_percentage": 80.0000, "estimated_amount": 16721, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 4577.54, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 4577, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 17348.7, "standard_charge_percentage": 83.0000, "estimated_amount": 17348, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 16721.6, "standard_charge_percentage": 80.0000, "estimated_amount": 16721, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7367.61, "estimated_amount": 7367, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 523.06, "estimated_amount": 523, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 7755.38, "estimated_amount": 7755, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 9665.96, "estimated_amount": 9665, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 16721.6, "standard_charge_percentage": 80.0000, "estimated_amount": 16721, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 13586.3, "standard_charge_percentage": 65.0000, "estimated_amount": 13586, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5455.42, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 9665.96, "estimated_amount": 9665, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 16721.6, "standard_charge_percentage": 80.0000, "estimated_amount": 16721, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 14631.4, "standard_charge_percentage": 70.0000, "estimated_amount": 14631, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 14840.4, "standard_charge_percentage": 71.0000, "estimated_amount": 14840, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 4577.54, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 4577, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 5748.05, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 5748, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6270.6, "standard_charge_percentage": 30.0000, "estimated_amount": 6270, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 16721.6, "standard_charge_percentage": 80.0000, "estimated_amount": 16721, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 15676.5, "standard_charge_percentage": 75.0000, "estimated_amount": 15676, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 7106.68, "standard_charge_percentage": 34.0000, "estimated_amount": 7106, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 523.06, "estimated_amount": 523, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "27696", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22872.9, "discounted_cash": 9680,"minimum": 488,"maximum": 18984.5,"payers_information":[{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 584.9, "estimated_amount": 584, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 584.9, "estimated_amount": 584, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 6290.06, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 6290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7367.61, "estimated_amount": 7367, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 16011.1, "standard_charge_percentage": 70.0000, "estimated_amount": 16011, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 18298.3, "standard_charge_percentage": 80.0000, "estimated_amount": 18298, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 7776.8, "standard_charge_percentage": 34.0000, "estimated_amount": 7776, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 6861.88, "standard_charge_percentage": 30.0000, "estimated_amount": 6861, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 17154.7, "standard_charge_percentage": 75.0000, "estimated_amount": 17154, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 9665.96, "estimated_amount": 9665, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 5009.17, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 5009, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 18298.3, "standard_charge_percentage": 80.0000, "estimated_amount": 18298, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 5009.17, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 5009, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 16239.8, "standard_charge_percentage": 71.0000, "estimated_amount": 16239, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 18298.3, "standard_charge_percentage": 80.0000, "estimated_amount": 18298, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 5009.17, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 5009, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 18298.3, "standard_charge_percentage": 80.0000, "estimated_amount": 18298, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 18984.5, "standard_charge_percentage": 83.0000, "estimated_amount": 18984, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 18298.3, "standard_charge_percentage": 80.0000, "estimated_amount": 18298, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 4574.59, "standard_charge_percentage": 20.0000, "estimated_amount": 4574, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 9665.96, "estimated_amount": 9665, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 9205.68, "estimated_amount": 9205, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 14867.4, "standard_charge_percentage": 65.0000, "estimated_amount": 14867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 7755.38, "estimated_amount": 7755, "methodology": "case rate" }]}]} , { "description": "Repair of ankle ligament", "code_information": [ { "code": "27698", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7685, "discounted_cash": 9680,"minimum": 488,"maximum": 7685,"payers_information":[{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 7367.61, "estimated_amount": 7367, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6148, "standard_charge_percentage": 80.0000, "estimated_amount": 6148, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1537, "standard_charge_percentage": 20.0000, "estimated_amount": 1537, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6148, "standard_charge_percentage": 80.0000, "estimated_amount": 6148, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 6378.55, "standard_charge_percentage": 83.0000, "estimated_amount": 6378, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1683.02, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 686.94, "estimated_amount": 686, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6148, "standard_charge_percentage": 80.0000, "estimated_amount": 6148, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5763.75, "standard_charge_percentage": 75.0000, "estimated_amount": 5763, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2113.38, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2113, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6148, "standard_charge_percentage": 80.0000, "estimated_amount": 6148, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2612.9, "standard_charge_percentage": 34.0000, "estimated_amount": 2612, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4995.25, "standard_charge_percentage": 65.0000, "estimated_amount": 4995, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2005.79, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2005, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1683.02, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1683, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5379.5, "standard_charge_percentage": 70.0000, "estimated_amount": 5379, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 686.94, "estimated_amount": 686, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6148, "standard_charge_percentage": 80.0000, "estimated_amount": 6148, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 7212.5, "estimated_amount": 7212, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2305.5, "standard_charge_percentage": 30.0000, "estimated_amount": 2305, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1683.02, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1683, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 5456.35, "standard_charge_percentage": 71.0000, "estimated_amount": 5456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 7685, "estimated_amount": 7685, "methodology": "fee schedule" }]}]} , { "description": "Removal of ankle implant", "code_information": [ { "code": "27704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16538, "discounted_cash": 4396,"minimum": 488,"maximum": 13726.5,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3621.82, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3621, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 13230.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5622.92, "standard_charge_percentage": 34.0000, "estimated_amount": 5622, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 10749.7, "standard_charge_percentage": 65.0000, "estimated_amount": 10749, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 12403.5, "standard_charge_percentage": 75.0000, "estimated_amount": 12403, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3621.82, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3621, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3307.6, "standard_charge_percentage": 20.0000, "estimated_amount": 3307, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4547.95, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4547, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 8182.34, "standard_charge_percentage": 53.2000, "estimated_amount": 8182, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 13230.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 8798.22, "standard_charge_percentage": 53.2000, "estimated_amount": 8798, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 611.54, "estimated_amount": 611, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 11742, "standard_charge_percentage": 71.0000, "estimated_amount": 11741, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 11576.6, "standard_charge_percentage": 70.0000, "estimated_amount": 11576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 611.54, "estimated_amount": 611, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4316.42, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4316, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8358.31, "standard_charge_percentage": 53.2000, "estimated_amount": 8358, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3621.82, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3621, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 13726.5, "standard_charge_percentage": 83.0000, "estimated_amount": 13726, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 13230.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4961.4, "standard_charge_percentage": 30.0000, "estimated_amount": 4961, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13230.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13230.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13230, "methodology": "percent of total billed charges" }]}]} , { "description": "Hc Clsd Treat Tibia Shaft Fx W Manip", "code_information": [ { "code": "27752", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4366, "discounted_cash": 2168,"minimum": 365,"maximum": 3805.04,"payers_information":[{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2837.9, "standard_charge_percentage": 65.0000, "estimated_amount": 2837, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3099.86, "standard_charge_percentage": 71.0000, "estimated_amount": 3099, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1442, "estimated_amount": 1442, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3274.5, "standard_charge_percentage": 75.0000, "estimated_amount": 3274, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 588.59, "estimated_amount": 588, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3580.12, "standard_charge_percentage": 82.0000, "estimated_amount": 3580, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3623.78, "standard_charge_percentage": 83.0000, "estimated_amount": 3623, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 588.59, "estimated_amount": 588, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3056.2, "standard_charge_percentage": 70.0000, "estimated_amount": 3056, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1139.53, "standard_charge_percentage": 26.1000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 873.2, "standard_charge_percentage": 20.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1484.44, "standard_charge_percentage": 34.0000, "estimated_amount": 1484, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1200.65, "standard_charge_percentage": 27.5000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1309.8, "standard_charge_percentage": 30.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" }]}]} , { "description": "Optx medial ankle fx", "code_information": [ { "code": "27766", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14317.3, "discounted_cash": 9680,"minimum": 558,"maximum": 14317.3,"payers_information":[{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4867.89, "standard_charge_percentage": 34.0000, "estimated_amount": 4867, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 11453.9, "standard_charge_percentage": 80.0000, "estimated_amount": 11453, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 11453.9, "standard_charge_percentage": 80.0000, "estimated_amount": 11453, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3135.5, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3135, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4295.2, "standard_charge_percentage": 30.0000, "estimated_amount": 4295, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 11584.9, "estimated_amount": 11584, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 10022.1, "standard_charge_percentage": 70.0000, "estimated_amount": 10022, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3736.82, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3736, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11453.9, "standard_charge_percentage": 80.0000, "estimated_amount": 11453, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11453.9, "standard_charge_percentage": 80.0000, "estimated_amount": 11453, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9306.26, "standard_charge_percentage": 65.0000, "estimated_amount": 9306, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2863.47, "standard_charge_percentage": 20.0000, "estimated_amount": 2863, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3135.5, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3135, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 11453.9, "standard_charge_percentage": 80.0000, "estimated_amount": 11453, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 11883.4, "standard_charge_percentage": 83.0000, "estimated_amount": 11883, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 658.71, "estimated_amount": 658, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 10738, "standard_charge_percentage": 75.0000, "estimated_amount": 10738, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3937.27, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3937, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 14317.3, "estimated_amount": 14317, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 10774, "estimated_amount": 10773, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3135.5, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3135, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 10165.3, "standard_charge_percentage": 71.0000, "estimated_amount": 10165, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11005.7, "estimated_amount": 11005, "methodology": "case rate" }]}]} , { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27788", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 695, "discounted_cash": 325,"minimum": 139,"maximum": 695,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 486.5, "standard_charge_percentage": 70.0000, "estimated_amount": 486, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 237.55, "estimated_amount": 237, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 350.07, "estimated_amount": 350, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 245.05, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 337.57, "estimated_amount": 337, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 695, "estimated_amount": 695, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 569.9, "standard_charge_percentage": 82.0000, "estimated_amount": 569, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 191.13, "standard_charge_percentage": 27.5000, "estimated_amount": 191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 312.56, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 576.85, "standard_charge_percentage": 83.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 405.08, "estimated_amount": 405, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 275.06, "estimated_amount": 275, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 451.75, "standard_charge_percentage": 65.0000, "estimated_amount": 451, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 208.5, "standard_charge_percentage": 30.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 236.3, "standard_charge_percentage": 34.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 139, "standard_charge_percentage": 20.0000, "estimated_amount": 139, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 300.06, "estimated_amount": 300, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 287.56, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 375.07, "estimated_amount": 375, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 467.34, "estimated_amount": 467, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 570.31, "estimated_amount": 570, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 467.34, "estimated_amount": 467, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 493.45, "standard_charge_percentage": 71.0000, "estimated_amount": 493, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 521.25, "standard_charge_percentage": 75.0000, "estimated_amount": 521, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 181.4, "standard_charge_percentage": 26.1000, "estimated_amount": 181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" }]}]} , { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27792", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23352, "discounted_cash": 9680,"minimum": 558,"maximum": 19382.2,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 6421.8, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 6421, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 16579.9, "standard_charge_percentage": 71.0000, "estimated_amount": 16579, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7005.6, "standard_charge_percentage": 30.0000, "estimated_amount": 7005, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 698.54, "estimated_amount": 698, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 5114.09, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 5114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11005.7, "estimated_amount": 11005, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 11584.9, "estimated_amount": 11584, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 698.54, "estimated_amount": 698, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 15178.8, "standard_charge_percentage": 65.0000, "estimated_amount": 15178, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 19382.2, "standard_charge_percentage": 83.0000, "estimated_amount": 19382, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 10774, "estimated_amount": 10773, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 4670.4, "standard_charge_percentage": 20.0000, "estimated_amount": 4670, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 5114.09, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 5114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 5114.09, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 5114, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 17514, "standard_charge_percentage": 75.0000, "estimated_amount": 17514, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 7939.68, "standard_charge_percentage": 34.0000, "estimated_amount": 7939, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 16346.4, "standard_charge_percentage": 70.0000, "estimated_amount": 16346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" }]}]} , { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27814", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33981, "discounted_cash": 9680,"minimum": 558,"maximum": 28204.2,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 830.87, "estimated_amount": 830, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 11553.5, "standard_charge_percentage": 34.0000, "estimated_amount": 11553, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 25485.8, "standard_charge_percentage": 75.0000, "estimated_amount": 25485, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 27184.8, "standard_charge_percentage": 80.0000, "estimated_amount": 27184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10194.3, "standard_charge_percentage": 30.0000, "estimated_amount": 10194, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 830.87, "estimated_amount": 830, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 6796.2, "standard_charge_percentage": 20.0000, "estimated_amount": 6796, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 11584.9, "estimated_amount": 11584, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 10774, "estimated_amount": 10773, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 24126.5, "standard_charge_percentage": 71.0000, "estimated_amount": 24126, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8889, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8889, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 27184.8, "standard_charge_percentage": 80.0000, "estimated_amount": 27184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 27184.8, "standard_charge_percentage": 80.0000, "estimated_amount": 27184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11005.7, "estimated_amount": 11005, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 27184.8, "standard_charge_percentage": 80.0000, "estimated_amount": 27184, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 23786.7, "standard_charge_percentage": 70.0000, "estimated_amount": 23786, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 27184.8, "standard_charge_percentage": 80.0000, "estimated_amount": 27184, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 22087.7, "standard_charge_percentage": 65.0000, "estimated_amount": 22087, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 28204.2, "standard_charge_percentage": 83.0000, "estimated_amount": 28204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" }]}]} , { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27818", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4366, "discounted_cash": 2168,"minimum": 365,"maximum": 3805.04,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1200.65, "standard_charge_percentage": 27.5000, "estimated_amount": 1200, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 544.98, "estimated_amount": 544, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 3580.12, "standard_charge_percentage": 82.0000, "estimated_amount": 3580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1442, "estimated_amount": 1442, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1139.53, "standard_charge_percentage": 26.1000, "estimated_amount": 1139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3056.2, "standard_charge_percentage": 70.0000, "estimated_amount": 3056, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2837.9, "standard_charge_percentage": 65.0000, "estimated_amount": 2837, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1484.44, "standard_charge_percentage": 34.0000, "estimated_amount": 1484, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3274.5, "standard_charge_percentage": 75.0000, "estimated_amount": 3274, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 873.2, "standard_charge_percentage": 20.0000, "estimated_amount": 873, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3623.78, "standard_charge_percentage": 83.0000, "estimated_amount": 3623, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1309.8, "standard_charge_percentage": 30.0000, "estimated_amount": 1309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 544.98, "estimated_amount": 544, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3099.86, "standard_charge_percentage": 71.0000, "estimated_amount": 3099, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3492.8, "standard_charge_percentage": 80.0000, "estimated_amount": 3492, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 956.15, "standard_charge_percentage": 21.9000, "estimated_amount": 956, "methodology": "percent of total billed charges" }]}]} , { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27822", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41170, "discounted_cash": 9680,"minimum": 558,"maximum": 34171.1,"payers_information":[{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 940.65, "estimated_amount": 940, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 29230.7, "standard_charge_percentage": 71.0000, "estimated_amount": 29230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 32936, "standard_charge_percentage": 80.0000, "estimated_amount": 32936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 12351, "standard_charge_percentage": 30.0000, "estimated_amount": 12351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 11584.9, "estimated_amount": 11584, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 26760.5, "standard_charge_percentage": 65.0000, "estimated_amount": 26760, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 13997.8, "standard_charge_percentage": 34.0000, "estimated_amount": 13997, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8889, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 8234, "standard_charge_percentage": 20.0000, "estimated_amount": 8234, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 10774, "estimated_amount": 10773, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 32936, "standard_charge_percentage": 80.0000, "estimated_amount": 32936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 30877.5, "standard_charge_percentage": 75.0000, "estimated_amount": 30877, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 32936, "standard_charge_percentage": 80.0000, "estimated_amount": 32936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11005.7, "estimated_amount": 11005, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 32936, "standard_charge_percentage": 80.0000, "estimated_amount": 32936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 940.65, "estimated_amount": 940, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 28819, "standard_charge_percentage": 70.0000, "estimated_amount": 28819, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 34171.1, "standard_charge_percentage": 83.0000, "estimated_amount": 34171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 32936, "standard_charge_percentage": 80.0000, "estimated_amount": 32936, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" }]}]} , { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27823", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8848, "discounted_cash": 9680,"minimum": 558,"maximum": 8848,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 8848, "estimated_amount": 8848, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 8848, "estimated_amount": 8848, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6282.08, "standard_charge_percentage": 71.0000, "estimated_amount": 6282, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3008.32, "standard_charge_percentage": 34.0000, "estimated_amount": 3008, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 8848, "estimated_amount": 8848, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 7078.4, "standard_charge_percentage": 80.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5751.2, "standard_charge_percentage": 65.0000, "estimated_amount": 5751, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8848, "estimated_amount": 8848, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1937.71, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 8848, "estimated_amount": 8848, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 7078.4, "standard_charge_percentage": 80.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2433.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2433, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2309.33, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2654.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2654, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1769.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1769, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 8848, "estimated_amount": 8848, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8848, "estimated_amount": 8848, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1937.71, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1937, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 8848, "estimated_amount": 8848, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 8848, "estimated_amount": 8848, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7343.84, "standard_charge_percentage": 83.0000, "estimated_amount": 7343, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7078.4, "standard_charge_percentage": 80.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1937.71, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 8848, "estimated_amount": 8848, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1062.4, "estimated_amount": 1062, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6636, "standard_charge_percentage": 75.0000, "estimated_amount": 6636, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 8848, "estimated_amount": 8848, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 7078.4, "standard_charge_percentage": 80.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6193.6, "standard_charge_percentage": 70.0000, "estimated_amount": 6193, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1062.4, "estimated_amount": 1062, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 8848, "estimated_amount": 8848, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7078.4, "standard_charge_percentage": 80.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" }]}]} , { "description": "Treat lower leg fracture", "code_information": [ { "code": "27827", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28826, "discounted_cash": 17436,"minimum": 558,"maximum": 28826,"payers_information":[{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 20178.2, "standard_charge_percentage": 70.0000, "estimated_amount": 20178, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 16095.2, "estimated_amount": 16095, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 18107, "estimated_amount": 18107, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 15424.5, "estimated_amount": 15424, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1213.07, "estimated_amount": 1213, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 16422, "estimated_amount": 16422, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 23060.8, "standard_charge_percentage": 80.0000, "estimated_amount": 23060, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 21619.5, "standard_charge_percentage": 75.0000, "estimated_amount": 21619, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 23060.8, "standard_charge_percentage": 80.0000, "estimated_amount": 23060, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 21728.5, "estimated_amount": 21728, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 20466.5, "standard_charge_percentage": 71.0000, "estimated_amount": 20466, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 12742, "estimated_amount": 12742, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6312.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6312, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 9800.84, "standard_charge_percentage": 34.0000, "estimated_amount": 9800, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 20118.9, "estimated_amount": 20118, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 7927.15, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 7927, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 18736.9, "standard_charge_percentage": 65.0000, "estimated_amount": 18736, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1213.07, "estimated_amount": 1213, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 18777.7, "estimated_amount": 18777, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8647.8, "standard_charge_percentage": 30.0000, "estimated_amount": 8647, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 23060.8, "standard_charge_percentage": 80.0000, "estimated_amount": 23060, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 28826, "estimated_amount": 28826, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 23060.8, "standard_charge_percentage": 80.0000, "estimated_amount": 23060, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 14753.9, "estimated_amount": 14753, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 23925.6, "standard_charge_percentage": 83.0000, "estimated_amount": 23925, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 17658.1, "estimated_amount": 17658, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 13144.4, "estimated_amount": 13144, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 16765.8, "estimated_amount": 16765, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 23060.8, "standard_charge_percentage": 80.0000, "estimated_amount": 23060, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 16775.2, "estimated_amount": 16775, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 5765.2, "standard_charge_percentage": 20.0000, "estimated_amount": 5765, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" }]}]} , { "description": "Treat lower leg joint", "code_information": [ { "code": "27829", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14325.9, "discounted_cash": 9680,"minimum": 488,"maximum": 14325.9,"payers_information":[{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 10171.4, "standard_charge_percentage": 71.0000, "estimated_amount": 10171, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 11890.5, "standard_charge_percentage": 83.0000, "estimated_amount": 11890, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3137.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4297.77, "standard_charge_percentage": 30.0000, "estimated_amount": 4297, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 758.71, "estimated_amount": 758, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 11460.7, "standard_charge_percentage": 80.0000, "estimated_amount": 11460, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3939.62, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11460.7, "standard_charge_percentage": 80.0000, "estimated_amount": 11460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3137.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3137, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3739.06, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3739, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9311.83, "standard_charge_percentage": 65.0000, "estimated_amount": 9311, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11005.7, "estimated_amount": 11005, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 10744.4, "standard_charge_percentage": 75.0000, "estimated_amount": 10744, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2865.18, "standard_charge_percentage": 20.0000, "estimated_amount": 2865, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 10028.1, "standard_charge_percentage": 70.0000, "estimated_amount": 10028, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 11460.7, "standard_charge_percentage": 80.0000, "estimated_amount": 11460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 14325.9, "estimated_amount": 14325, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 758.71, "estimated_amount": 758, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 11584.9, "estimated_amount": 11584, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3137.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3137, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 10774, "estimated_amount": 10773, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 11460.7, "standard_charge_percentage": 80.0000, "estimated_amount": 11460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4870.8, "standard_charge_percentage": 34.0000, "estimated_amount": 4870, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11460.7, "standard_charge_percentage": 80.0000, "estimated_amount": 11460, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" }]}]} , { "description": "Treat ankle dislocation", "code_information": [ { "code": "27840", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 695, "discounted_cash": 325,"minimum": 139,"maximum": 695,"payers_information":[{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 245.05, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 300.06, "estimated_amount": 300, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 337.57, "estimated_amount": 337, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 181.4, "standard_charge_percentage": 26.1000, "estimated_amount": 181, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 236.3, "standard_charge_percentage": 34.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 576.85, "standard_charge_percentage": 83.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 287.56, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 405.08, "estimated_amount": 405, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 695, "estimated_amount": 695, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 428.81, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 451.75, "standard_charge_percentage": 65.0000, "estimated_amount": 451, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 208.5, "standard_charge_percentage": 30.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 486.5, "standard_charge_percentage": 70.0000, "estimated_amount": 486, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 569.9, "standard_charge_percentage": 82.0000, "estimated_amount": 569, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 570.31, "estimated_amount": 570, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 350.07, "estimated_amount": 350, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 428.81, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 275.06, "estimated_amount": 275, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 521.25, "standard_charge_percentage": 75.0000, "estimated_amount": 521, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 191.13, "standard_charge_percentage": 27.5000, "estimated_amount": 191, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 237.55, "estimated_amount": 237, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 375.07, "estimated_amount": 375, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 312.56, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 139, "standard_charge_percentage": 20.0000, "estimated_amount": 139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 493.45, "standard_charge_percentage": 71.0000, "estimated_amount": 493, "methodology": "percent of total billed charges" }]}]} , { "description": "Exploration of foot joint", "code_information": [ { "code": "28022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9720, "discounted_cash": 4396,"minimum": 488,"maximum": 8067.6,"payers_information":[{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 7776, "standard_charge_percentage": 80.0000, "estimated_amount": 7776, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6804, "standard_charge_percentage": 70.0000, "estimated_amount": 6804, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 6318, "standard_charge_percentage": 65.0000, "estimated_amount": 6318, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 8067.6, "standard_charge_percentage": 83.0000, "estimated_amount": 8067, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 496.37, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6901.2, "standard_charge_percentage": 71.0000, "estimated_amount": 6901, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2128.68, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2128, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7776, "standard_charge_percentage": 80.0000, "estimated_amount": 7776, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3304.8, "standard_charge_percentage": 34.0000, "estimated_amount": 3304, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7776, "standard_charge_percentage": 80.0000, "estimated_amount": 7776, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2536.92, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2536, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2128.68, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2128, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2673, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2673, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2128.68, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2128, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 7776, "standard_charge_percentage": 80.0000, "estimated_amount": 7776, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1944, "standard_charge_percentage": 20.0000, "estimated_amount": 1944, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 7290, "standard_charge_percentage": 75.0000, "estimated_amount": 7290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 496.37, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2916, "standard_charge_percentage": 30.0000, "estimated_amount": 2916, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 7776, "standard_charge_percentage": 80.0000, "estimated_amount": 7776, "methodology": "percent of total billed charges" }]}]} , { "description": "Decompression of tibia nerve", "code_information": [ { "code": "28035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5627.25, "discounted_cash": 2646,"minimum": 547.98,"maximum": 5508.75,"payers_information":[{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 2137.38, "estimated_amount": 2137, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3939.07, "standard_charge_percentage": 70.0000, "estimated_amount": 3939, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3995.35, "standard_charge_percentage": 71.0000, "estimated_amount": 3995, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4501.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4501, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 4642.8, "estimated_amount": 4642, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 2239.16, "estimated_amount": 2239, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1232.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1232, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2035.6, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4501.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1913.27, "standard_charge_percentage": 34.0000, "estimated_amount": 1913, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2544.5, "estimated_amount": 2544, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2035.6, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1232.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1232, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1688.17, "standard_charge_percentage": 30.0000, "estimated_amount": 1688, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4220.44, "standard_charge_percentage": 75.0000, "estimated_amount": 4220, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2035.6, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 5508.75, "estimated_amount": 5508, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 3053.4, "estimated_amount": 3053, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4501.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 2096.67, "estimated_amount": 2096, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2035.6, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2035.6, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2035.6, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2035.6, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4501.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2035.6, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2035.6, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 2340.94, "estimated_amount": 2340, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4501.8, "standard_charge_percentage": 80.0000, "estimated_amount": 4501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 2096.67, "estimated_amount": 2096, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2442.72, "estimated_amount": 2442, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2035.6, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5233.31, "estimated_amount": 5233, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2035.6, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2748.06, "estimated_amount": 2748, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 2137.38, "estimated_amount": 2137, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1468.71, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1468, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2035.6, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2035.6, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 547.98, "estimated_amount": 547, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2035.6, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1994.89, "estimated_amount": 1994, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 3155.18, "estimated_amount": 3155, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2035.6, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4124.79, "estimated_amount": 4124, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 3155.18, "estimated_amount": 3155, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 3297.67, "estimated_amount": 3297, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 2096.67, "estimated_amount": 2096, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3657.71, "standard_charge_percentage": 65.0000, "estimated_amount": 3657, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 2137.38, "estimated_amount": 2137, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1232.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1232, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2035.6, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 4670.62, "standard_charge_percentage": 83.0000, "estimated_amount": 4670, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1547.49, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1547, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1933.82, "estimated_amount": 1933, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2035.6, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 3928.37, "estimated_amount": 3928, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1125.45, "standard_charge_percentage": 20.0000, "estimated_amount": 1125, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 547.98, "estimated_amount": 547, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 2137.38, "estimated_amount": 2137, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5123.14, "estimated_amount": 5123, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2035.6, "estimated_amount": 2035, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2849.84, "estimated_amount": 2849, "methodology": "fee schedule" }]}]} , { "description": "Exc foottoe tum sc 1.5 cm>", "code_information": [ { "code": "28039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6877, "discounted_cash": 3878,"minimum": 483.75,"maximum": 6804.65,"payers_information":[{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4813.9, "standard_charge_percentage": 70.0000, "estimated_amount": 4813, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1506.06, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1506, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2338.18, "standard_charge_percentage": 34.0000, "estimated_amount": 2338, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 483.75, "estimated_amount": 483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1794.9, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1794, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 3475.64, "standard_charge_percentage": 53.2000, "estimated_amount": 3475, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4882.67, "standard_charge_percentage": 71.0000, "estimated_amount": 4882, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5501.6, "standard_charge_percentage": 80.0000, "estimated_amount": 5501, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5157.75, "standard_charge_percentage": 75.0000, "estimated_amount": 5157, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2063.1, "standard_charge_percentage": 30.0000, "estimated_amount": 2063, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5501.6, "standard_charge_percentage": 80.0000, "estimated_amount": 5501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1506.06, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1506, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5501.6, "standard_charge_percentage": 80.0000, "estimated_amount": 5501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 3658.56, "standard_charge_percentage": 53.2000, "estimated_amount": 3658, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1506.06, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1506, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5707.91, "standard_charge_percentage": 83.0000, "estimated_amount": 5707, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5501.6, "standard_charge_percentage": 80.0000, "estimated_amount": 5501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1375.4, "standard_charge_percentage": 20.0000, "estimated_amount": 1375, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2200.64, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2200, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4470.05, "standard_charge_percentage": 65.0000, "estimated_amount": 4470, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 483.75, "estimated_amount": 483, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5501.6, "standard_charge_percentage": 80.0000, "estimated_amount": 5501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1891.17, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1891, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 3402.46, "standard_charge_percentage": 53.2000, "estimated_amount": 3402, "methodology": "percent of total billed charges" }]}]} , { "description": "Exc foot/toe tum sc < 1.5 cm", "code_information": [ { "code": "28043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7501, "discounted_cash": 2195,"minimum": 387.73,"maximum": 6225.83,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1642.72, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1642, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2364.56, "estimated_amount": 2364, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2533.45, "estimated_amount": 2533, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 5325.71, "standard_charge_percentage": 71.0000, "estimated_amount": 5325, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6000.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4875.65, "standard_charge_percentage": 65.0000, "estimated_amount": 4875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1942.32, "estimated_amount": 1942, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5759.08, "estimated_amount": 5759, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1857.87, "estimated_amount": 1857, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1655.19, "estimated_amount": 1655, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6000.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 387.73, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1642.72, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1642, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2111.21, "estimated_amount": 2111, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2280.11, "estimated_amount": 2280, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1642.72, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1642, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2736.13, "estimated_amount": 2736, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5882.93, "estimated_amount": 5882, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 387.73, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1604.52, "estimated_amount": 1604, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5250.7, "standard_charge_percentage": 70.0000, "estimated_amount": 5250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6000.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1500.2, "standard_charge_percentage": 20.0000, "estimated_amount": 1500, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2026.76, "estimated_amount": 2026, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6192.56, "estimated_amount": 6192, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2617.9, "estimated_amount": 2617, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6000.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1739.64, "estimated_amount": 1739, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2247.22, "estimated_amount": 2247, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2062.78, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2062, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2250.3, "standard_charge_percentage": 30.0000, "estimated_amount": 2250, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1957.76, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1957, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2550.34, "standard_charge_percentage": 34.0000, "estimated_amount": 2550, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2359.58, "estimated_amount": 2359, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3852.2, "estimated_amount": 3852, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5625.75, "standard_charge_percentage": 75.0000, "estimated_amount": 5625, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1773.42, "estimated_amount": 1773, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6000.8, "standard_charge_percentage": 80.0000, "estimated_amount": 6000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1688.97, "estimated_amount": 1688, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 6225.83, "standard_charge_percentage": 83.0000, "estimated_amount": 6225, "methodology": "percent of total billed charges" }]}]} , { "description": "Exc foottoe tum deep <1.5cm", "code_information": [ { "code": "28045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12636.4, "discounted_cash": 3878,"minimum": 493.06,"maximum": 10488.2,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4027.66, "estimated_amount": 4027, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3475.01, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3475, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 493.06, "estimated_amount": 493, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10488.2, "standard_charge_percentage": 83.0000, "estimated_amount": 10488, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6804.65, "estimated_amount": 6804, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2767.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 493.06, "estimated_amount": 493, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4475.18, "estimated_amount": 4475, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2767.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2767, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3298.1, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3298, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10109.1, "standard_charge_percentage": 80.0000, "estimated_amount": 10109, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3281.8, "estimated_amount": 3281, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 2923.78, "estimated_amount": 2923, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2527.28, "standard_charge_percentage": 20.0000, "estimated_amount": 2527, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10109.1, "standard_charge_percentage": 80.0000, "estimated_amount": 10109, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3430.97, "estimated_amount": 3430, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4176.83, "estimated_amount": 4176, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9477.29, "standard_charge_percentage": 75.0000, "estimated_amount": 9477, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3132.62, "estimated_amount": 3132, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 8971.84, "standard_charge_percentage": 71.0000, "estimated_amount": 8971, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4624.35, "estimated_amount": 4624, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2767.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2767, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 2834.28, "estimated_amount": 2834, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4296.37, "standard_charge_percentage": 34.0000, "estimated_amount": 4296, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 3729.31, "estimated_amount": 3729, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3790.92, "standard_charge_percentage": 30.0000, "estimated_amount": 3790, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 8845.47, "standard_charge_percentage": 70.0000, "estimated_amount": 8845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10109.1, "standard_charge_percentage": 80.0000, "estimated_amount": 10109, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8213.65, "standard_charge_percentage": 65.0000, "estimated_amount": 8213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 3580.14, "estimated_amount": 3580, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4833.19, "estimated_amount": 4833, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3072.95, "estimated_amount": 3072, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 2983.45, "estimated_amount": 2983, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10109.1, "standard_charge_percentage": 80.0000, "estimated_amount": 10109, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10109.1, "standard_charge_percentage": 80.0000, "estimated_amount": 10109, "methodology": "percent of total billed charges" }]}]} , { "description": "Partial removal foot fascia", "code_information": [ { "code": "28060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8559, "discounted_cash": 4396,"minimum": 488,"maximum": 7714.21,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5991.3, "standard_charge_percentage": 70.0000, "estimated_amount": 5991, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2910.06, "standard_charge_percentage": 34.0000, "estimated_amount": 2910, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6847.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6847, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6847.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6847, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1874.42, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1711.8, "standard_charge_percentage": 20.0000, "estimated_amount": 1711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5563.35, "standard_charge_percentage": 65.0000, "estimated_amount": 5563, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2353.72, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2353, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 528.1, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6419.25, "standard_charge_percentage": 75.0000, "estimated_amount": 6419, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7103.97, "standard_charge_percentage": 83.0000, "estimated_amount": 7103, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6847.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6847, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1874.42, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6847.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6847, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6076.89, "standard_charge_percentage": 71.0000, "estimated_amount": 6076, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6847.2, "standard_charge_percentage": 80.0000, "estimated_amount": 6847, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2567.7, "standard_charge_percentage": 30.0000, "estimated_amount": 2567, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 528.1, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1874.42, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2233.9, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2233, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10963.3, "discounted_cash": 2168,"minimum": 548.95,"maximum": 9099.57,"payers_information":[{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 8222.5, "standard_charge_percentage": 75.0000, "estimated_amount": 8222, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7674.34, "standard_charge_percentage": 70.0000, "estimated_amount": 7674, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7126.17, "standard_charge_percentage": 65.0000, "estimated_amount": 7126, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2400.97, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2400, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2400.97, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2400, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2192.67, "standard_charge_percentage": 20.0000, "estimated_amount": 2192, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 548.95, "estimated_amount": 548, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2861.43, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2861, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8770.67, "standard_charge_percentage": 80.0000, "estimated_amount": 8770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 548.95, "estimated_amount": 548, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 9099.57, "standard_charge_percentage": 83.0000, "estimated_amount": 9099, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8770.67, "standard_charge_percentage": 80.0000, "estimated_amount": 8770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8770.67, "standard_charge_percentage": 80.0000, "estimated_amount": 8770, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3289, "standard_charge_percentage": 30.0000, "estimated_amount": 3289, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2400.97, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2400, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8770.67, "standard_charge_percentage": 80.0000, "estimated_amount": 8770, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8770.67, "standard_charge_percentage": 80.0000, "estimated_amount": 8770, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3014.92, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3014, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3727.54, "standard_charge_percentage": 34.0000, "estimated_amount": 3727, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7783.97, "standard_charge_percentage": 71.0000, "estimated_amount": 7783, "methodology": "percent of total billed charges" }]}]} , { "description": "Removal of foot lesion", "code_information": [ { "code": "28090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10068, "discounted_cash": 2168,"minimum": 474.37,"maximum": 8356.44,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2204.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2204, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2627.75, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2627, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2204.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2204, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2204.89, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2204, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 7551, "standard_charge_percentage": 75.0000, "estimated_amount": 7551, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3020.4, "standard_charge_percentage": 30.0000, "estimated_amount": 3020, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7047.6, "standard_charge_percentage": 70.0000, "estimated_amount": 7047, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2768.7, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2768, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7148.28, "standard_charge_percentage": 71.0000, "estimated_amount": 7148, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8054.4, "standard_charge_percentage": 80.0000, "estimated_amount": 8054, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 8356.44, "standard_charge_percentage": 83.0000, "estimated_amount": 8356, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2013.6, "standard_charge_percentage": 20.0000, "estimated_amount": 2013, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 474.37, "estimated_amount": 474, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3423.12, "standard_charge_percentage": 34.0000, "estimated_amount": 3423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 6544.2, "standard_charge_percentage": 65.0000, "estimated_amount": 6544, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 474.37, "estimated_amount": 474, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" }]}]} , { "description": "Removal of toe lesions", "code_information": [ { "code": "28092", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8528, "discounted_cash": 2168,"minimum": 428.2,"maximum": 7078.24,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5969.6, "standard_charge_percentage": 70.0000, "estimated_amount": 5969, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2345.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2345, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2899.52, "standard_charge_percentage": 34.0000, "estimated_amount": 2899, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6054.88, "standard_charge_percentage": 71.0000, "estimated_amount": 6054, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 428.2, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2558.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2558, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2225.81, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2225, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 428.2, "estimated_amount": 428, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1705.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7078.24, "standard_charge_percentage": 83.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6396, "standard_charge_percentage": 75.0000, "estimated_amount": 6396, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5543.2, "standard_charge_percentage": 65.0000, "estimated_amount": 5543, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6150.68, "discounted_cash": 4396,"minimum": 488,"maximum": 6150.68,"payers_information":[{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 633.89, "estimated_amount": 633, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4613.01, "standard_charge_percentage": 75.0000, "estimated_amount": 4613, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1347, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1347, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4920.54, "standard_charge_percentage": 80.0000, "estimated_amount": 4920, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4920.54, "standard_charge_percentage": 80.0000, "estimated_amount": 4920, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6150.68, "estimated_amount": 6150, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1605.33, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1605, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6150.68, "estimated_amount": 6150, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4366.98, "standard_charge_percentage": 71.0000, "estimated_amount": 4366, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2091.23, "standard_charge_percentage": 34.0000, "estimated_amount": 2091, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6150.68, "estimated_amount": 6150, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6150.68, "estimated_amount": 6150, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1691.44, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1691, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6150.68, "estimated_amount": 6150, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1347, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1347, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1230.14, "standard_charge_percentage": 20.0000, "estimated_amount": 1230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4305.48, "standard_charge_percentage": 70.0000, "estimated_amount": 4305, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4920.54, "standard_charge_percentage": 80.0000, "estimated_amount": 4920, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6150.68, "estimated_amount": 6150, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6150.68, "estimated_amount": 6150, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1347, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1347, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6150.68, "estimated_amount": 6150, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 633.89, "estimated_amount": 633, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3997.94, "standard_charge_percentage": 65.0000, "estimated_amount": 3997, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6150.68, "estimated_amount": 6150, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4920.54, "standard_charge_percentage": 80.0000, "estimated_amount": 4920, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1845.2, "standard_charge_percentage": 30.0000, "estimated_amount": 1845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6150.68, "estimated_amount": 6150, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4920.54, "standard_charge_percentage": 80.0000, "estimated_amount": 4920, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5105.06, "standard_charge_percentage": 83.0000, "estimated_amount": 5105, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" }]}]} , { "description": "Removal of foot lesion", "code_information": [ { "code": "28104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9562.5, "discounted_cash": 4396,"minimum": 488,"maximum": 7936.88,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3251.25, "standard_charge_percentage": 34.0000, "estimated_amount": 3251, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 541.71, "estimated_amount": 541, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2495.81, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2495, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1912.5, "standard_charge_percentage": 20.0000, "estimated_amount": 1912, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 7171.88, "standard_charge_percentage": 75.0000, "estimated_amount": 7171, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2094.19, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2094, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2094.19, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2094, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2094.19, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2094, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 7650, "standard_charge_percentage": 80.0000, "estimated_amount": 7650, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6789.38, "standard_charge_percentage": 71.0000, "estimated_amount": 6789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7650, "standard_charge_percentage": 80.0000, "estimated_amount": 7650, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6693.75, "standard_charge_percentage": 70.0000, "estimated_amount": 6693, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2629.69, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2629, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 7650, "standard_charge_percentage": 80.0000, "estimated_amount": 7650, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 6215.63, "standard_charge_percentage": 65.0000, "estimated_amount": 6215, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 541.71, "estimated_amount": 541, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7650, "standard_charge_percentage": 80.0000, "estimated_amount": 7650, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2868.75, "standard_charge_percentage": 30.0000, "estimated_amount": 2868, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7936.88, "standard_charge_percentage": 83.0000, "estimated_amount": 7936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 7650, "standard_charge_percentage": 80.0000, "estimated_amount": 7650, "methodology": "percent of total billed charges" }]}]} , { "description": "Part removal of metatarsal", "code_information": [ { "code": "28110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11097, "discounted_cash": 4396,"minimum": 471.91,"maximum": 9210.51,"payers_information":[{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2219.4, "standard_charge_percentage": 20.0000, "estimated_amount": 2219, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 471.91, "estimated_amount": 471, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3329.1, "standard_charge_percentage": 30.0000, "estimated_amount": 3329, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7213.05, "standard_charge_percentage": 65.0000, "estimated_amount": 7213, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3051.68, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3051, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 8322.75, "standard_charge_percentage": 75.0000, "estimated_amount": 8322, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 471.91, "estimated_amount": 471, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2896.32, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2896, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 9210.51, "standard_charge_percentage": 83.0000, "estimated_amount": 9210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3772.98, "standard_charge_percentage": 34.0000, "estimated_amount": 3772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7767.9, "standard_charge_percentage": 70.0000, "estimated_amount": 7767, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7878.87, "standard_charge_percentage": 71.0000, "estimated_amount": 7878, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" }]}]} , { "description": "Part removal of metatarsal", "code_information": [ { "code": "28111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17759, "discounted_cash": 4396,"minimum": 482.63,"maximum": 14740,"payers_information":[{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 14740, "standard_charge_percentage": 83.0000, "estimated_amount": 14739, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 482.63, "estimated_amount": 482, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4883.73, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4883, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5327.7, "standard_charge_percentage": 30.0000, "estimated_amount": 5327, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 12608.9, "standard_charge_percentage": 71.0000, "estimated_amount": 12608, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 482.63, "estimated_amount": 482, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14207.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 13319.3, "standard_charge_percentage": 75.0000, "estimated_amount": 13319, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3889.22, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3551.8, "standard_charge_percentage": 20.0000, "estimated_amount": 3551, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 6038.06, "standard_charge_percentage": 34.0000, "estimated_amount": 6038, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 14207.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14207, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 12431.3, "standard_charge_percentage": 70.0000, "estimated_amount": 12431, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3889.22, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 11543.4, "standard_charge_percentage": 65.0000, "estimated_amount": 11543, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14207.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4635.1, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4635, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 14207.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3889.22, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 14207.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14207, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4330.1, "discounted_cash": 4396,"minimum": 490.86,"maximum": 4330.1,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 948.29, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 948, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3247.57, "standard_charge_percentage": 75.0000, "estimated_amount": 3247, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4330.1, "estimated_amount": 4330, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 4330.1, "estimated_amount": 4330, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3464.08, "standard_charge_percentage": 80.0000, "estimated_amount": 3464, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1130.16, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1130, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 490.86, "estimated_amount": 490, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 866.02, "standard_charge_percentage": 20.0000, "estimated_amount": 866, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4330.1, "estimated_amount": 4330, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4330.1, "estimated_amount": 4330, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4330.1, "estimated_amount": 4330, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4330.1, "estimated_amount": 4330, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3593.98, "standard_charge_percentage": 83.0000, "estimated_amount": 3593, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 948.29, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 948, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2814.57, "standard_charge_percentage": 65.0000, "estimated_amount": 2814, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4330.1, "estimated_amount": 4330, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 490.86, "estimated_amount": 490, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4330.1, "estimated_amount": 4330, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3464.08, "standard_charge_percentage": 80.0000, "estimated_amount": 3464, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 948.29, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 948, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1472.23, "standard_charge_percentage": 34.0000, "estimated_amount": 1472, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1190.78, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1190, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3464.08, "standard_charge_percentage": 80.0000, "estimated_amount": 3464, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1299.03, "standard_charge_percentage": 30.0000, "estimated_amount": 1299, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3074.37, "standard_charge_percentage": 71.0000, "estimated_amount": 3074, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4330.1, "estimated_amount": 4330, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3464.08, "standard_charge_percentage": 80.0000, "estimated_amount": 3464, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3464.08, "standard_charge_percentage": 80.0000, "estimated_amount": 3464, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3031.07, "standard_charge_percentage": 70.0000, "estimated_amount": 3031, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4330.1, "estimated_amount": 4330, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4330.1, "estimated_amount": 4330, "methodology": "fee schedule" }]}]} , { "description": "Part removal of metatarsal", "code_information": [ { "code": "28113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13104, "discounted_cash": 4396,"minimum": 558,"maximum": 10876.3,"payers_information":[{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3603.6, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8517.6, "standard_charge_percentage": 65.0000, "estimated_amount": 8517, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10876.3, "standard_charge_percentage": 83.0000, "estimated_amount": 10876, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2620.8, "standard_charge_percentage": 20.0000, "estimated_amount": 2620, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9828, "standard_charge_percentage": 75.0000, "estimated_amount": 9828, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4455.36, "standard_charge_percentage": 34.0000, "estimated_amount": 4455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3420.14, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3931.2, "standard_charge_percentage": 30.0000, "estimated_amount": 3931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9172.8, "standard_charge_percentage": 70.0000, "estimated_amount": 9172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9303.84, "standard_charge_percentage": 71.0000, "estimated_amount": 9303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 597.55, "estimated_amount": 597, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 597.55, "estimated_amount": 597, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8923.34, "discounted_cash": 4396,"minimum": 558,"maximum": 7714.21,"payers_information":[{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 7138.67, "standard_charge_percentage": 80.0000, "estimated_amount": 7138, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 694.49, "estimated_amount": 694, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1954.21, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1954.21, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1954, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7406.37, "standard_charge_percentage": 83.0000, "estimated_amount": 7406, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7138.67, "standard_charge_percentage": 80.0000, "estimated_amount": 7138, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6692.51, "standard_charge_percentage": 75.0000, "estimated_amount": 6692, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 694.49, "estimated_amount": 694, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2453.92, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2453, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1784.67, "standard_charge_percentage": 20.0000, "estimated_amount": 1784, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5800.17, "standard_charge_percentage": 65.0000, "estimated_amount": 5800, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3033.94, "standard_charge_percentage": 34.0000, "estimated_amount": 3033, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6335.57, "standard_charge_percentage": 71.0000, "estimated_amount": 6335, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2328.99, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7138.67, "standard_charge_percentage": 80.0000, "estimated_amount": 7138, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 7138.67, "standard_charge_percentage": 80.0000, "estimated_amount": 7138, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1954.21, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2677, "standard_charge_percentage": 30.0000, "estimated_amount": 2677, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6246.34, "standard_charge_percentage": 70.0000, "estimated_amount": 6246, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 7138.67, "standard_charge_percentage": 80.0000, "estimated_amount": 7138, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" }]}]} , { "description": "Removal of heel bone", "code_information": [ { "code": "28118", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16195, "discounted_cash": 4396,"minimum": 626.79,"maximum": 13441.9,"payers_information":[{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3546.7, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3546, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 12146.3, "standard_charge_percentage": 75.0000, "estimated_amount": 12146, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 12956, "standard_charge_percentage": 80.0000, "estimated_amount": 12956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12956, "standard_charge_percentage": 80.0000, "estimated_amount": 12956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3239, "standard_charge_percentage": 20.0000, "estimated_amount": 3239, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 13441.9, "standard_charge_percentage": 83.0000, "estimated_amount": 13441, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4858.5, "standard_charge_percentage": 30.0000, "estimated_amount": 4858, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4226.9, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4226, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 12956, "standard_charge_percentage": 80.0000, "estimated_amount": 12956, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 10526.8, "standard_charge_percentage": 65.0000, "estimated_amount": 10526, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 626.79, "estimated_amount": 626, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3546.7, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3546, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 11336.5, "standard_charge_percentage": 70.0000, "estimated_amount": 11336, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 626.79, "estimated_amount": 626, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 12956, "standard_charge_percentage": 80.0000, "estimated_amount": 12956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4453.63, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4453, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 11498.5, "standard_charge_percentage": 71.0000, "estimated_amount": 11498, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3546.7, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3546, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5506.3, "standard_charge_percentage": 34.0000, "estimated_amount": 5506, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12956, "standard_charge_percentage": 80.0000, "estimated_amount": 12956, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" }]}]} , { "description": "Removal of heel spur", "code_information": [ { "code": "28119", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11097, "discounted_cash": 4396,"minimum": 536.63,"maximum": 9210.51,"payers_information":[{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 536.63, "estimated_amount": 536, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2219.4, "standard_charge_percentage": 20.0000, "estimated_amount": 2219, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3772.98, "standard_charge_percentage": 34.0000, "estimated_amount": 3772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2896.32, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2896, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7878.87, "standard_charge_percentage": 71.0000, "estimated_amount": 7878, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 536.63, "estimated_amount": 536, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7213.05, "standard_charge_percentage": 65.0000, "estimated_amount": 7213, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7767.9, "standard_charge_percentage": 70.0000, "estimated_amount": 7767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3329.1, "standard_charge_percentage": 30.0000, "estimated_amount": 3329, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3051.68, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3051, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 8322.75, "standard_charge_percentage": 75.0000, "estimated_amount": 8322, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 9210.51, "standard_charge_percentage": 83.0000, "estimated_amount": 9210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9394.72, "discounted_cash": 4396,"minimum": 690.29,"maximum": 7797.62,"payers_information":[{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 690.29, "estimated_amount": 690, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 7515.78, "standard_charge_percentage": 80.0000, "estimated_amount": 7515, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2057.44, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2057, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 3647, "estimated_amount": 3647, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7515.78, "standard_charge_percentage": 80.0000, "estimated_amount": 7515, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1878.94, "standard_charge_percentage": 20.0000, "estimated_amount": 1878, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 7046.04, "standard_charge_percentage": 75.0000, "estimated_amount": 7046, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 6106.57, "standard_charge_percentage": 65.0000, "estimated_amount": 6106, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3194.2, "standard_charge_percentage": 34.0000, "estimated_amount": 3194, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2583.55, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2583, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 1090, "estimated_amount": 1090, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7515.78, "standard_charge_percentage": 80.0000, "estimated_amount": 7515, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6576.3, "standard_charge_percentage": 70.0000, "estimated_amount": 6576, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2452.02, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2452, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2057.44, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2057, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 690.29, "estimated_amount": 690, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 7515.78, "standard_charge_percentage": 80.0000, "estimated_amount": 7515, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7797.62, "standard_charge_percentage": 83.0000, "estimated_amount": 7797, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2818.42, "standard_charge_percentage": 30.0000, "estimated_amount": 2818, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 7515.78, "standard_charge_percentage": 80.0000, "estimated_amount": 7515, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 6232, "estimated_amount": 6232, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6670.25, "standard_charge_percentage": 71.0000, "estimated_amount": 6670, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2057.44, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2057, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" }]}]} , { "description": "Partial removal of foot bone", "code_information": [ { "code": "28122", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6380, "discounted_cash": 4396,"minimum": 558,"maximum": 6380,"payers_information":[{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4529.8, "standard_charge_percentage": 71.0000, "estimated_amount": 4529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6380, "estimated_amount": 6380, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2169.2, "standard_charge_percentage": 34.0000, "estimated_amount": 2169, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4785, "standard_charge_percentage": 75.0000, "estimated_amount": 4785, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4147, "standard_charge_percentage": 65.0000, "estimated_amount": 4147, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1397.22, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1397, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5295.4, "standard_charge_percentage": 83.0000, "estimated_amount": 5295, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 607.7, "estimated_amount": 607, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6380, "estimated_amount": 6380, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5104, "standard_charge_percentage": 80.0000, "estimated_amount": 5104, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5104, "standard_charge_percentage": 80.0000, "estimated_amount": 5104, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6380, "estimated_amount": 6380, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6380, "estimated_amount": 6380, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1914, "standard_charge_percentage": 30.0000, "estimated_amount": 1914, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5104, "standard_charge_percentage": 80.0000, "estimated_amount": 5104, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4466, "standard_charge_percentage": 70.0000, "estimated_amount": 4466, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1665.18, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1665, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1754.5, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1754, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6380, "estimated_amount": 6380, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6380, "estimated_amount": 6380, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 607.7, "estimated_amount": 607, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5104, "standard_charge_percentage": 80.0000, "estimated_amount": 5104, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6380, "estimated_amount": 6380, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1397.22, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1397, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1397.22, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1397, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6380, "estimated_amount": 6380, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6380, "estimated_amount": 6380, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1276, "standard_charge_percentage": 20.0000, "estimated_amount": 1276, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5104, "standard_charge_percentage": 80.0000, "estimated_amount": 5104, "methodology": "percent of total billed charges" }]}]} , { "description": "Partial removal of toe", "code_information": [ { "code": "28124", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9261, "discounted_cash": 4396,"minimum": 486.72,"maximum": 7714.21,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 7408.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 6482.7, "standard_charge_percentage": 70.0000, "estimated_amount": 6482, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2028.16, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2028, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 7408.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 486.72, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6575.31, "standard_charge_percentage": 71.0000, "estimated_amount": 6575, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2028.16, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2028, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1852.2, "standard_charge_percentage": 20.0000, "estimated_amount": 1852, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 6019.65, "standard_charge_percentage": 65.0000, "estimated_amount": 6019, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2778.3, "standard_charge_percentage": 30.0000, "estimated_amount": 2778, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 7408.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7686.63, "standard_charge_percentage": 83.0000, "estimated_amount": 7686, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2417.12, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2417, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2546.78, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2546, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3148.74, "standard_charge_percentage": 34.0000, "estimated_amount": 3148, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 486.72, "estimated_amount": 486, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2963.52, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2963, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2028.16, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2028, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6945.75, "standard_charge_percentage": 75.0000, "estimated_amount": 6945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 7408.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7408, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 7408.8, "standard_charge_percentage": 80.0000, "estimated_amount": 7408, "methodology": "percent of total billed charges" }]}]} , { "description": "Partial removal of toe", "code_information": [ { "code": "28126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6855, "discounted_cash": 4396,"minimum": 395.51,"maximum": 6855,"payers_information":[{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1501.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5141.25, "standard_charge_percentage": 75.0000, "estimated_amount": 5141, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4798.5, "standard_charge_percentage": 70.0000, "estimated_amount": 4798, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2056.5, "standard_charge_percentage": 30.0000, "estimated_amount": 2056, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 395.51, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5484, "standard_charge_percentage": 80.0000, "estimated_amount": 5484, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1789.15, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1789, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5484, "standard_charge_percentage": 80.0000, "estimated_amount": 5484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 395.51, "estimated_amount": 395, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4455.75, "standard_charge_percentage": 65.0000, "estimated_amount": 4455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4867.05, "standard_charge_percentage": 71.0000, "estimated_amount": 4867, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 6855, "estimated_amount": 6855, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5484, "standard_charge_percentage": 80.0000, "estimated_amount": 5484, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1501.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1501, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1371, "standard_charge_percentage": 20.0000, "estimated_amount": 1371, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1885.13, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1885, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2330.7, "standard_charge_percentage": 34.0000, "estimated_amount": 2330, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1501.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1501, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5484, "standard_charge_percentage": 80.0000, "estimated_amount": 5484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5484, "standard_charge_percentage": 80.0000, "estimated_amount": 5484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5689.65, "standard_charge_percentage": 83.0000, "estimated_amount": 5689, "methodology": "percent of total billed charges" }]}]} , { "description": "Partial removal of toe", "code_information": [ { "code": "28160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4397.6, "discounted_cash": 4396,"minimum": 413.59,"maximum": 4397.6,"payers_information":[{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4397.6, "estimated_amount": 4397, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4397.6, "estimated_amount": 4397, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 413.59, "estimated_amount": 413, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4397.6, "estimated_amount": 4397, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3518.08, "standard_charge_percentage": 80.0000, "estimated_amount": 3518, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3518.08, "standard_charge_percentage": 80.0000, "estimated_amount": 3518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 879.52, "standard_charge_percentage": 20.0000, "estimated_amount": 879, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 963.07, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 963, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1495.18, "standard_charge_percentage": 34.0000, "estimated_amount": 1495, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4397.6, "estimated_amount": 4397, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4397.6, "estimated_amount": 4397, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3518.08, "standard_charge_percentage": 80.0000, "estimated_amount": 3518, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 963.07, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 963, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2858.44, "standard_charge_percentage": 65.0000, "estimated_amount": 2858, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4397.6, "estimated_amount": 4397, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3122.3, "standard_charge_percentage": 71.0000, "estimated_amount": 3122, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1209.34, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1209, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4397.6, "estimated_amount": 4397, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3518.08, "standard_charge_percentage": 80.0000, "estimated_amount": 3518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4397.6, "estimated_amount": 4397, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1147.77, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1147, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3650.01, "standard_charge_percentage": 83.0000, "estimated_amount": 3650, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 413.59, "estimated_amount": 413, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3518.08, "standard_charge_percentage": 80.0000, "estimated_amount": 3518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1319.28, "standard_charge_percentage": 30.0000, "estimated_amount": 1319, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 3078.32, "standard_charge_percentage": 70.0000, "estimated_amount": 3078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3298.2, "standard_charge_percentage": 75.0000, "estimated_amount": 3298, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4397.6, "estimated_amount": 4397, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 4397.6, "estimated_amount": 4397, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 963.07, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 963, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4397.6, "estimated_amount": 4397, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" }]}]} , { "description": "Removal of foot foreign body", "code_information": [ { "code": "28190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8528, "discounted_cash": 953,"minimum": 240.67,"maximum": 7078.24,"payers_information":[{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 240.67, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 1936, "standard_charge_percentage": 80.0000, "estimated_amount": 1936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1718.2, "standard_charge_percentage": 71.0000, "estimated_amount": 1718, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1174.42, "estimated_amount": 1174, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1573, "standard_charge_percentage": 65.0000, "estimated_amount": 1573, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 240.67, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 529.98, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1815, "standard_charge_percentage": 75.0000, "estimated_amount": 1815, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 1936, "standard_charge_percentage": 80.0000, "estimated_amount": 1936, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 990.13, "estimated_amount": 990, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 5543.2, "standard_charge_percentage": 65.0000, "estimated_amount": 5543, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 484, "standard_charge_percentage": 20.0000, "estimated_amount": 484, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 5969.6, "standard_charge_percentage": 70.0000, "estimated_amount": 5969, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1672.81, "estimated_amount": 1672, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 2008.6, "standard_charge_percentage": 83.0000, "estimated_amount": 2008, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 1136.82, "estimated_amount": 1136, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 529.98, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 7078.24, "standard_charge_percentage": 83.0000, "estimated_amount": 7078, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 726, "standard_charge_percentage": 30.0000, "estimated_amount": 726, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 1936, "standard_charge_percentage": 80.0000, "estimated_amount": 1936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 718.76, "estimated_amount": 718, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1705.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1705, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1199.68, "estimated_amount": 1199, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 240.67, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 6396, "standard_charge_percentage": 75.0000, "estimated_amount": 6396, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 2420, "estimated_amount": 2420, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1188.16, "estimated_amount": 1188, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 822.8, "standard_charge_percentage": 34.0000, "estimated_amount": 822, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 1672.81, "estimated_amount": 1672, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 916.79, "estimated_amount": 916, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 529.98, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 529, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 665.5, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 665, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 696.76, "estimated_amount": 696, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 2728.96, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 2728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 1936, "standard_charge_percentage": 80.0000, "estimated_amount": 1936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 1199.68, "estimated_amount": 1199, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 1936, "standard_charge_percentage": 80.0000, "estimated_amount": 1936, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 1188.16, "estimated_amount": 1188, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 631.62, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 631, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1262.82, "estimated_amount": 1262, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 843.44, "estimated_amount": 843, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 240.67, "estimated_amount": 240, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 806.77, "estimated_amount": 806, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2345.2, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2345, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 1174.42, "estimated_amount": 1174, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 6054.88, "standard_charge_percentage": 71.0000, "estimated_amount": 6054, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2225.81, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2225, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 1262.82, "estimated_amount": 1262, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 554.41, "estimated_amount": 554, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1867.63, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1867, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 774.4, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 774, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 755.43, "estimated_amount": 755, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 770.1, "estimated_amount": 770, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 733.43, "estimated_amount": 733, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 1100.14, "estimated_amount": 1100, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1694, "standard_charge_percentage": 70.0000, "estimated_amount": 1694, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2558.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2558, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 6822.4, "standard_charge_percentage": 80.0000, "estimated_amount": 6822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2899.52, "standard_charge_percentage": 34.0000, "estimated_amount": 2899, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 528.01, "estimated_amount": 528, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 880.12, "estimated_amount": 880, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 1026.8, "estimated_amount": 1026, "methodology": "fee schedule" }]}]} , { "description": "Repair of foot tendon", "code_information": [ { "code": "28200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11216, "discounted_cash": 4396,"minimum": 504.67,"maximum": 9309.28,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7290.4, "standard_charge_percentage": 65.0000, "estimated_amount": 7290, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2243.2, "standard_charge_percentage": 20.0000, "estimated_amount": 2243, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8972.8, "standard_charge_percentage": 80.0000, "estimated_amount": 8972, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2456.3, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7851.2, "standard_charge_percentage": 70.0000, "estimated_amount": 7851, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8972.8, "standard_charge_percentage": 80.0000, "estimated_amount": 8972, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8972.8, "standard_charge_percentage": 80.0000, "estimated_amount": 8972, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2456.3, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2456.3, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2456, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3813.44, "standard_charge_percentage": 34.0000, "estimated_amount": 3813, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8972.8, "standard_charge_percentage": 80.0000, "estimated_amount": 8972, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 504.67, "estimated_amount": 504, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2927.38, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2927, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 9309.28, "standard_charge_percentage": 83.0000, "estimated_amount": 9309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8972.8, "standard_charge_percentage": 80.0000, "estimated_amount": 8972, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3084.4, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3084, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 504.67, "estimated_amount": 504, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7963.36, "standard_charge_percentage": 71.0000, "estimated_amount": 7963, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3364.8, "standard_charge_percentage": 30.0000, "estimated_amount": 3364, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 8412, "standard_charge_percentage": 75.0000, "estimated_amount": 8412, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" }]}]} , { "description": "Incision of foot tendon(s)", "code_information": [ { "code": "28230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15111, "discounted_cash": 2168,"minimum": 439.77,"maximum": 12542.1,"payers_information":[{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4155.52, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3022.2, "standard_charge_percentage": 20.0000, "estimated_amount": 3022, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 3777.75, "standard_charge_percentage": 25.0000, "estimated_amount": 3777, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 10577.7, "standard_charge_percentage": 70.0000, "estimated_amount": 10577, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9822.15, "standard_charge_percentage": 65.0000, "estimated_amount": 9822, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 10728.8, "standard_charge_percentage": 71.0000, "estimated_amount": 10728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 439.77, "estimated_amount": 439, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4533.3, "standard_charge_percentage": 30.0000, "estimated_amount": 4533, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 12542.1, "standard_charge_percentage": 83.0000, "estimated_amount": 12542, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3943.97, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3943, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4835.52, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 4835, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5137.74, "standard_charge_percentage": 34.0000, "estimated_amount": 5137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 439.77, "estimated_amount": 439, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 11333.3, "standard_charge_percentage": 75.0000, "estimated_amount": 11333, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" }]}]} , { "description": "Incision of toe tendon", "code_information": [ { "code": "28232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2613, "discounted_cash": 2168,"minimum": 379.11,"maximum": 2613,"payers_information":[{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 888.42, "standard_charge_percentage": 34.0000, "estimated_amount": 888, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2613, "estimated_amount": 2613, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 572.25, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 572, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2613, "estimated_amount": 2613, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 681.99, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 681, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 2613, "estimated_amount": 2613, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 2613, "estimated_amount": 2613, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 572.25, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 572, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2613, "estimated_amount": 2613, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 572.25, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 572, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 379.11, "estimated_amount": 379, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2613, "estimated_amount": 2613, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 2090.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2090, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 1855.23, "standard_charge_percentage": 71.0000, "estimated_amount": 1855, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 718.58, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 718, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2613, "estimated_amount": 2613, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 1829.1, "standard_charge_percentage": 70.0000, "estimated_amount": 1829, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 379.11, "estimated_amount": 379, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 522.6, "standard_charge_percentage": 20.0000, "estimated_amount": 522, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 2168.79, "standard_charge_percentage": 83.0000, "estimated_amount": 2168, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 2090.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2090, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 1698.45, "standard_charge_percentage": 65.0000, "estimated_amount": 1698, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 2613, "estimated_amount": 2613, "methodology": "case rate" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 836.16, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 836, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 653.25, "standard_charge_percentage": 25.0000, "estimated_amount": 653, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2613, "estimated_amount": 2613, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 1959.75, "standard_charge_percentage": 75.0000, "estimated_amount": 1959, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 783.9, "standard_charge_percentage": 30.0000, "estimated_amount": 783, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2613, "estimated_amount": 2613, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 2613, "estimated_amount": 2613, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 2090.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2090, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2613, "estimated_amount": 2613, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 2090.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2090, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 2090.4, "standard_charge_percentage": 80.0000, "estimated_amount": 2090, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 2613, "estimated_amount": 2613, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2613, "estimated_amount": 2613, "methodology": "fee schedule" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4279.5, "discounted_cash": 2168,"minimum": 416.44,"maximum": 4279.5,"payers_information":[{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 2335.61, "estimated_amount": 2335, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 1634.92, "estimated_amount": 1634, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1283.85, "standard_charge_percentage": 30.0000, "estimated_amount": 1283, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 2085.36, "estimated_amount": 2085, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 416.44, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 937.21, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4279.5, "estimated_amount": 4279, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 2502.43, "estimated_amount": 2502, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3551.99, "standard_charge_percentage": 83.0000, "estimated_amount": 3551, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3209.63, "standard_charge_percentage": 75.0000, "estimated_amount": 3209, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 2252.19, "estimated_amount": 2252, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3423.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3423, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4279.5, "estimated_amount": 4279, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3038.45, "standard_charge_percentage": 71.0000, "estimated_amount": 3038, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4279.5, "estimated_amount": 4279, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3423.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3423.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 2585.85, "estimated_amount": 2585, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2781.68, "standard_charge_percentage": 65.0000, "estimated_amount": 2781, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 855.9, "standard_charge_percentage": 20.0000, "estimated_amount": 855, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 416.44, "estimated_amount": 416, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 1918.53, "estimated_amount": 1918, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 3805.04, "estimated_amount": 3805, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4279.5, "estimated_amount": 4279, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2995.65, "standard_charge_percentage": 70.0000, "estimated_amount": 2995, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 937.21, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 1751.7, "estimated_amount": 1751, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1176.86, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1176, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3423.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3423.6, "standard_charge_percentage": 80.0000, "estimated_amount": 3423, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 2702.63, "estimated_amount": 2702, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 1584.88, "estimated_amount": 1584, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1455.03, "standard_charge_percentage": 34.0000, "estimated_amount": 1455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 2001.95, "estimated_amount": 2001, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 1835.12, "estimated_amount": 1835, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 937.21, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 937, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 1718.34, "estimated_amount": 1718, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 1668.29, "estimated_amount": 1668, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1116.95, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1116, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13860.5, "discounted_cash": 9680,"minimum": 558,"maximum": 13860.5,"payers_information":[{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 683.07, "estimated_amount": 683, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4158.15, "standard_charge_percentage": 30.0000, "estimated_amount": 4158, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9009.33, "standard_charge_percentage": 65.0000, "estimated_amount": 9009, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 12608.8, "estimated_amount": 12608, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 683.07, "estimated_amount": 683, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11978.4, "estimated_amount": 11978, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2772.1, "standard_charge_percentage": 20.0000, "estimated_amount": 2772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 11504.2, "standard_charge_percentage": 83.0000, "estimated_amount": 11504, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3035.45, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3035, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3035.45, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3035, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 11088.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11088, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4712.57, "standard_charge_percentage": 34.0000, "estimated_amount": 4712, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11088.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11088.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3617.59, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3617, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 10395.4, "standard_charge_percentage": 75.0000, "estimated_amount": 10395, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 11088.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 11726.2, "estimated_amount": 11726, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3811.64, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3811, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 11088.4, "standard_charge_percentage": 80.0000, "estimated_amount": 11088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9840.95, "standard_charge_percentage": 71.0000, "estimated_amount": 9840, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3035.45, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3035, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 13860.5, "estimated_amount": 13860, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9702.35, "standard_charge_percentage": 70.0000, "estimated_amount": 9702, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" }]}]} , { "description": "Release of foot contracture", "code_information": [ { "code": "28270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5726.08, "discounted_cash": 4396,"minimum": 496,"maximum": 5726.08,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5726.08, "estimated_amount": 5726, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1574.67, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1574, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 496, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 4580.86, "standard_charge_percentage": 80.0000, "estimated_amount": 4580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1717.82, "standard_charge_percentage": 30.0000, "estimated_amount": 1717, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1145.22, "standard_charge_percentage": 20.0000, "estimated_amount": 1145, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1254.01, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1254, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 4580.86, "standard_charge_percentage": 80.0000, "estimated_amount": 4580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1254.01, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1254, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5726.08, "estimated_amount": 5726, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 5726.08, "estimated_amount": 5726, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 3721.95, "standard_charge_percentage": 65.0000, "estimated_amount": 3721, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1946.87, "standard_charge_percentage": 34.0000, "estimated_amount": 1946, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4008.26, "standard_charge_percentage": 70.0000, "estimated_amount": 4008, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1254.01, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1254, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 4580.86, "standard_charge_percentage": 80.0000, "estimated_amount": 4580, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 4294.56, "standard_charge_percentage": 75.0000, "estimated_amount": 4294, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 5726.08, "estimated_amount": 5726, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 4752.65, "standard_charge_percentage": 83.0000, "estimated_amount": 4752, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 4580.86, "standard_charge_percentage": 80.0000, "estimated_amount": 4580, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 496, "estimated_amount": 496, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 4580.86, "standard_charge_percentage": 80.0000, "estimated_amount": 4580, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1494.51, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1494, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4065.52, "standard_charge_percentage": 71.0000, "estimated_amount": 4065, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" }]}]} , { "description": "Repair of hammertoe", "code_information": [ { "code": "28285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10222, "discounted_cash": 4396,"minimum": 553.79,"maximum": 8484.26,"payers_information":[{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8177.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8177, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2044.4, "standard_charge_percentage": 20.0000, "estimated_amount": 2044, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 553.79, "estimated_amount": 553, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8177.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8177, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2238.62, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2238, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2238.62, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2238, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 553.79, "estimated_amount": 553, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8177.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8177, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2667.94, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2667, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 8484.26, "standard_charge_percentage": 83.0000, "estimated_amount": 8484, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 6644.3, "standard_charge_percentage": 65.0000, "estimated_amount": 6644, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7257.62, "standard_charge_percentage": 71.0000, "estimated_amount": 7257, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 2811.05, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 2811, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3475.48, "standard_charge_percentage": 34.0000, "estimated_amount": 3475, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8177.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8177, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2238.62, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2238, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8177.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8177, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 7666.5, "standard_charge_percentage": 75.0000, "estimated_amount": 7666, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3066.6, "standard_charge_percentage": 30.0000, "estimated_amount": 3066, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7155.4, "standard_charge_percentage": 70.0000, "estimated_amount": 7155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" }]}]} , { "description": "Partial Removal Of Foot Bone", "code_information": [ { "code": "28288", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11097, "discounted_cash": 4396,"minimum": 558,"maximum": 9210.51,"payers_information":[{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7878.87, "standard_charge_percentage": 71.0000, "estimated_amount": 7878, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 614.43, "estimated_amount": 614, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2896.32, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2896, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7767.9, "standard_charge_percentage": 70.0000, "estimated_amount": 7767, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3772.98, "standard_charge_percentage": 34.0000, "estimated_amount": 3772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3329.1, "standard_charge_percentage": 30.0000, "estimated_amount": 3329, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2219.4, "standard_charge_percentage": 20.0000, "estimated_amount": 2219, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 9210.51, "standard_charge_percentage": 83.0000, "estimated_amount": 9210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3051.68, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3051, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 8322.75, "standard_charge_percentage": 75.0000, "estimated_amount": 8322, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 614.43, "estimated_amount": 614, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7213.05, "standard_charge_percentage": 65.0000, "estimated_amount": 7213, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" }]}]} , { "description": "Corrj halux rigdus wo implt", "code_information": [ { "code": "28289", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11898, "discounted_cash": 4396,"minimum": 558,"maximum": 9875.34,"payers_information":[{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2605.66, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2605, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4045.32, "standard_charge_percentage": 34.0000, "estimated_amount": 4045, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 8447.58, "standard_charge_percentage": 71.0000, "estimated_amount": 8447, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 704.16, "estimated_amount": 704, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2605.66, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2605, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 9875.34, "standard_charge_percentage": 83.0000, "estimated_amount": 9875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3569.4, "standard_charge_percentage": 30.0000, "estimated_amount": 3569, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 9518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 9518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9518, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3271.95, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3271, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 8328.6, "standard_charge_percentage": 70.0000, "estimated_amount": 8328, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7733.7, "standard_charge_percentage": 65.0000, "estimated_amount": 7733, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 8923.5, "standard_charge_percentage": 75.0000, "estimated_amount": 8923, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2379.6, "standard_charge_percentage": 20.0000, "estimated_amount": 2379, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3105.38, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3105, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 9518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9518, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 9518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 9518.4, "standard_charge_percentage": 80.0000, "estimated_amount": 9518, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 704.16, "estimated_amount": 704, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2605.66, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2605, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" }]}]} , { "description": "Corrj halux rigdus wimplt", "code_information": [ { "code": "28291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24471, "discounted_cash": 9680,"minimum": 693.42,"maximum": 20310.9,"payers_information":[{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 19576.8, "standard_charge_percentage": 80.0000, "estimated_amount": 19576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 13018.6, "standard_charge_percentage": 53.2000, "estimated_amount": 13018, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 693.42, "estimated_amount": 693, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 5359.15, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 5359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 693.42, "estimated_amount": 693, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 15906.2, "standard_charge_percentage": 65.0000, "estimated_amount": 15906, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 19576.8, "standard_charge_percentage": 80.0000, "estimated_amount": 19576, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 18353.3, "standard_charge_percentage": 75.0000, "estimated_amount": 18353, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 17374.4, "standard_charge_percentage": 71.0000, "estimated_amount": 17374, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 7830.72, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 7830, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 4894.2, "standard_charge_percentage": 20.0000, "estimated_amount": 4894, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 6729.52, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 6729, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7341.3, "standard_charge_percentage": 30.0000, "estimated_amount": 7341, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 17129.7, "standard_charge_percentage": 70.0000, "estimated_amount": 17129, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 20310.9, "standard_charge_percentage": 83.0000, "estimated_amount": 20310, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 19576.8, "standard_charge_percentage": 80.0000, "estimated_amount": 19576, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 12107.3, "standard_charge_percentage": 53.2000, "estimated_amount": 12107, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 19576.8, "standard_charge_percentage": 80.0000, "estimated_amount": 19576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 12367.6, "standard_charge_percentage": 53.2000, "estimated_amount": 12367, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 5359.15, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 5359, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 5359.15, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 5359, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 6117.75, "standard_charge_percentage": 25.0000, "estimated_amount": 6117, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 19576.8, "standard_charge_percentage": 80.0000, "estimated_amount": 19576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 8320.14, "standard_charge_percentage": 34.0000, "estimated_amount": 8320, "methodology": "percent of total billed charges" }]}]} , { "description": "Cor hlx vlgs rsc prx phlx bs", "code_information": [ { "code": "28292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17376, "discounted_cash": 4396,"minimum": 488,"maximum": 14422.1,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 11294.4, "standard_charge_percentage": 65.0000, "estimated_amount": 11294, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 712.89, "estimated_amount": 712, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4535.14, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4535, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13900.8, "standard_charge_percentage": 80.0000, "estimated_amount": 13900, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 13900.8, "standard_charge_percentage": 80.0000, "estimated_amount": 13900, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3805.34, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3805, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3805.34, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3805, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 712.89, "estimated_amount": 712, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3475.2, "standard_charge_percentage": 20.0000, "estimated_amount": 3475, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13900.8, "standard_charge_percentage": 80.0000, "estimated_amount": 13900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5907.84, "standard_charge_percentage": 34.0000, "estimated_amount": 5907, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 8103.78, "estimated_amount": 8103, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 13900.8, "standard_charge_percentage": 80.0000, "estimated_amount": 13900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 14422.1, "standard_charge_percentage": 83.0000, "estimated_amount": 14422, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8278.05, "estimated_amount": 8278, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 12337, "standard_charge_percentage": 71.0000, "estimated_amount": 12336, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4778.4, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4778, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 13900.8, "standard_charge_percentage": 80.0000, "estimated_amount": 13900, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 8713.74, "estimated_amount": 8713, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 12163.2, "standard_charge_percentage": 70.0000, "estimated_amount": 12163, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3805.34, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3805, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 13032, "standard_charge_percentage": 75.0000, "estimated_amount": 13032, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5212.8, "standard_charge_percentage": 30.0000, "estimated_amount": 5212, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" }]}]} , { "description": "Cor hlx vlgs prx mtar osteot", "code_information": [ { "code": "28295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35508.5, "discounted_cash": 4396,"minimum": 1055.05,"maximum": 29472,"payers_information":[{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1055.05, "estimated_amount": 1055, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 18890.5, "standard_charge_percentage": 53.2000, "estimated_amount": 18890, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 12072.9, "standard_charge_percentage": 34.0000, "estimated_amount": 12072, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 8877.12, "standard_charge_percentage": 25.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 28406.8, "standard_charge_percentage": 80.0000, "estimated_amount": 28406, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 24855.9, "standard_charge_percentage": 70.0000, "estimated_amount": 24855, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 28406.8, "standard_charge_percentage": 80.0000, "estimated_amount": 28406, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 7101.69, "standard_charge_percentage": 20.0000, "estimated_amount": 7101, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 17946, "standard_charge_percentage": 53.2000, "estimated_amount": 17945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1055.05, "estimated_amount": 1055, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10652.5, "standard_charge_percentage": 30.0000, "estimated_amount": 10652, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 29472, "standard_charge_percentage": 83.0000, "estimated_amount": 29472, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 23080.5, "standard_charge_percentage": 65.0000, "estimated_amount": 23080, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8889, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 28406.8, "standard_charge_percentage": 80.0000, "estimated_amount": 28406, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 9528, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 9528, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 25211, "standard_charge_percentage": 71.0000, "estimated_amount": 25211, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 26631.3, "standard_charge_percentage": 75.0000, "estimated_amount": 26631, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 17568.2, "standard_charge_percentage": 53.2000, "estimated_amount": 17568, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 28406.8, "standard_charge_percentage": 80.0000, "estimated_amount": 28406, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 28406.8, "standard_charge_percentage": 80.0000, "estimated_amount": 28406, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" }]}]} , { "description": "Cor hlx vlgs dstl mtar osteo", "code_information": [ { "code": "28296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14480, "discounted_cash": 4396,"minimum": 558,"maximum": 12018.4,"payers_information":[{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3171.12, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3171, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3779.28, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3779, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4344, "standard_charge_percentage": 30.0000, "estimated_amount": 4344, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 891.77, "estimated_amount": 891, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 10136, "standard_charge_percentage": 70.0000, "estimated_amount": 10136, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2896, "standard_charge_percentage": 20.0000, "estimated_amount": 2896, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3171.12, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3171, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 8103.78, "estimated_amount": 8103, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9412, "standard_charge_percentage": 65.0000, "estimated_amount": 9412, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4923.2, "standard_charge_percentage": 34.0000, "estimated_amount": 4923, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 8713.74, "estimated_amount": 8713, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 12018.4, "standard_charge_percentage": 83.0000, "estimated_amount": 12018, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11584, "standard_charge_percentage": 80.0000, "estimated_amount": 11584, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 10860, "standard_charge_percentage": 75.0000, "estimated_amount": 10860, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 10280.8, "standard_charge_percentage": 71.0000, "estimated_amount": 10280, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 11584, "standard_charge_percentage": 80.0000, "estimated_amount": 11584, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 11584, "standard_charge_percentage": 80.0000, "estimated_amount": 11584, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8278.05, "estimated_amount": 8278, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3982, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3982, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3171.12, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3171, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 11584, "standard_charge_percentage": 80.0000, "estimated_amount": 11584, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 891.77, "estimated_amount": 891, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11584, "standard_charge_percentage": 80.0000, "estimated_amount": 11584, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" }]}]} , { "description": "Cor hlx vlgs jt arthrd", "code_information": [ { "code": "28297", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28665, "discounted_cash": 17436,"minimum": 558,"maximum": 28665,"payers_information":[{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 22932, "standard_charge_percentage": 80.0000, "estimated_amount": 22932, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 16095.2, "estimated_amount": 16095, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 18777.7, "estimated_amount": 18777, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 12742, "estimated_amount": 12742, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 15424.5, "estimated_amount": 15424, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 20118.9, "estimated_amount": 20118, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 13144.4, "estimated_amount": 13144, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 21728.5, "estimated_amount": 21728, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 16765.8, "estimated_amount": 16765, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 18632.3, "standard_charge_percentage": 65.0000, "estimated_amount": 18632, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 20352.2, "standard_charge_percentage": 71.0000, "estimated_amount": 20352, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 18107, "estimated_amount": 18107, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 22932, "standard_charge_percentage": 80.0000, "estimated_amount": 22932, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 8713.74, "estimated_amount": 8713, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 20065.5, "standard_charge_percentage": 70.0000, "estimated_amount": 20065, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 21498.8, "standard_charge_percentage": 75.0000, "estimated_amount": 21498, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1028.62, "estimated_amount": 1028, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 23792, "standard_charge_percentage": 83.0000, "estimated_amount": 23791, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8599.5, "standard_charge_percentage": 30.0000, "estimated_amount": 8599, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 8103.78, "estimated_amount": 8103, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 22932, "standard_charge_percentage": 80.0000, "estimated_amount": 22932, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 9746.1, "standard_charge_percentage": 34.0000, "estimated_amount": 9746, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 14753.9, "estimated_amount": 14753, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 22932, "standard_charge_percentage": 80.0000, "estimated_amount": 22932, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8278.05, "estimated_amount": 8278, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6277.64, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6277, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 7882.88, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 7882, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 22932, "standard_charge_percentage": 80.0000, "estimated_amount": 22932, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1028.62, "estimated_amount": 1028, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 28665, "estimated_amount": 28665, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 5733, "standard_charge_percentage": 20.0000, "estimated_amount": 5733, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" }]}]} , { "description": "Cor hlx vlgs prx phlx osteot", "code_information": [ { "code": "28298", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13104, "discounted_cash": 9680,"minimum": 558,"maximum": 13104,"payers_information":[{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4455.36, "standard_charge_percentage": 34.0000, "estimated_amount": 4455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8278.05, "estimated_amount": 8278, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 8103.78, "estimated_amount": 8103, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 845.27, "estimated_amount": 845, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3420.14, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9828, "standard_charge_percentage": 75.0000, "estimated_amount": 9828, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2620.8, "standard_charge_percentage": 20.0000, "estimated_amount": 2620, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9172.8, "standard_charge_percentage": 70.0000, "estimated_amount": 9172, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3603.6, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3931.2, "standard_charge_percentage": 30.0000, "estimated_amount": 3931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10876.3, "standard_charge_percentage": 83.0000, "estimated_amount": 10876, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8517.6, "standard_charge_percentage": 65.0000, "estimated_amount": 8517, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9303.84, "standard_charge_percentage": 71.0000, "estimated_amount": 9303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 845.27, "estimated_amount": 845, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 13104, "estimated_amount": 13104, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 8713.74, "estimated_amount": 8713, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" }]}]} , { "description": "Cor hlx vlgs double osteot", "code_information": [ { "code": "28299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15111, "discounted_cash": 9680,"minimum": 785,"maximum": 15111,"payers_information":[{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 785, "estimated_amount": 785, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 5150, "estimated_amount": 5150, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3022.2, "standard_charge_percentage": 20.0000, "estimated_amount": 3022, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 1025.67, "estimated_amount": 1025, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4155.52, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8278.05, "estimated_amount": 8278, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 10577.7, "standard_charge_percentage": 70.0000, "estimated_amount": 10577, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 8103.78, "estimated_amount": 8103, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5137.74, "standard_charge_percentage": 34.0000, "estimated_amount": 5137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 15111, "estimated_amount": 15111, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 11333.3, "standard_charge_percentage": 75.0000, "estimated_amount": 11333, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 10728.8, "standard_charge_percentage": 71.0000, "estimated_amount": 10728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 1025.67, "estimated_amount": 1025, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2836, "estimated_amount": 2836, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 12542.1, "standard_charge_percentage": 83.0000, "estimated_amount": 12542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9822.15, "standard_charge_percentage": 65.0000, "estimated_amount": 9822, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4533.3, "standard_charge_percentage": 30.0000, "estimated_amount": 4533, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 8713.74, "estimated_amount": 8713, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3943.97, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3943, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" }]}]} , { "description": "Incision of midfoot bones", "code_information": [ { "code": "28304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18025.5, "discounted_cash": 9680,"minimum": 488,"maximum": 16984.6,"payers_information":[{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 13519.1, "standard_charge_percentage": 75.0000, "estimated_amount": 13519, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 863.85, "estimated_amount": 863, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11978.4, "estimated_amount": 11978, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3947.58, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3947, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 12617.9, "standard_charge_percentage": 70.0000, "estimated_amount": 12617, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3947.58, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3947, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 14420.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 11716.6, "standard_charge_percentage": 65.0000, "estimated_amount": 11716, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4704.66, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4704, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14420.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4957.01, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4957, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14420.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5407.65, "standard_charge_percentage": 30.0000, "estimated_amount": 5407, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 863.85, "estimated_amount": 863, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 6128.67, "standard_charge_percentage": 34.0000, "estimated_amount": 6128, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3605.1, "standard_charge_percentage": 20.0000, "estimated_amount": 3605, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 12798.1, "standard_charge_percentage": 71.0000, "estimated_amount": 12798, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 11726.2, "estimated_amount": 11726, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 12608.8, "estimated_amount": 12608, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3947.58, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3947, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 14961.2, "standard_charge_percentage": 83.0000, "estimated_amount": 14961, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 14420.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 14420.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14420, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" }]}]} , { "description": "Incision of metatarsal", "code_information": [ { "code": "28306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13104, "discounted_cash": 9680,"minimum": 625.22,"maximum": 13104,"payers_information":[{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3931.2, "standard_charge_percentage": 30.0000, "estimated_amount": 3931, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 625.22, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 13104, "estimated_amount": 13104, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10876.3, "standard_charge_percentage": 83.0000, "estimated_amount": 10876, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8517.6, "standard_charge_percentage": 65.0000, "estimated_amount": 8517, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2620.8, "standard_charge_percentage": 20.0000, "estimated_amount": 2620, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4455.36, "standard_charge_percentage": 34.0000, "estimated_amount": 4455, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9172.8, "standard_charge_percentage": 70.0000, "estimated_amount": 9172, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3420.14, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3420, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9828, "standard_charge_percentage": 75.0000, "estimated_amount": 9828, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9303.84, "standard_charge_percentage": 71.0000, "estimated_amount": 9303, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 625.22, "estimated_amount": 625, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2869.78, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2869, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10483.2, "standard_charge_percentage": 80.0000, "estimated_amount": 10483, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3603.6, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" }]}]} , { "description": "Incision of metatarsal", "code_information": [ { "code": "28308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15111, "discounted_cash": 4396,"minimum": 488,"maximum": 12542.1,"payers_information":[{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 583.93, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 583.93, "estimated_amount": 583, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3943.97, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3943, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5137.74, "standard_charge_percentage": 34.0000, "estimated_amount": 5137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3022.2, "standard_charge_percentage": 20.0000, "estimated_amount": 3022, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4155.52, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 10577.7, "standard_charge_percentage": 70.0000, "estimated_amount": 10577, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 10728.8, "standard_charge_percentage": 71.0000, "estimated_amount": 10728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 12542.1, "standard_charge_percentage": 83.0000, "estimated_amount": 12542, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9822.15, "standard_charge_percentage": 65.0000, "estimated_amount": 9822, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4533.3, "standard_charge_percentage": 30.0000, "estimated_amount": 4533, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 11333.3, "standard_charge_percentage": 75.0000, "estimated_amount": 11333, "methodology": "percent of total billed charges" }]}]} , { "description": "Chemodenerv 1 extrem 1-4 ea", "code_information": [ { "code": "28476", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4226.4, "discounted_cash": 4396,"minimum": 415.21,"maximum": 4226.4,"payers_information":[{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 3000.74, "standard_charge_percentage": 71.0000, "estimated_amount": 3000, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 2747.16, "standard_charge_percentage": 65.0000, "estimated_amount": 2747, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 2958.48, "standard_charge_percentage": 70.0000, "estimated_amount": 2958, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 3507.91, "standard_charge_percentage": 83.0000, "estimated_amount": 3507, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 3381.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3381, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 845.28, "standard_charge_percentage": 20.0000, "estimated_amount": 845, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 3381.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3381, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 415.21, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 3381.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3381, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 925.58, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 925, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 3169.8, "standard_charge_percentage": 75.0000, "estimated_amount": 3169, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 3381.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3381, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 415.21, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 1436.98, "standard_charge_percentage": 34.0000, "estimated_amount": 1436, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "case rate" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1162.26, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1162, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 3381.12, "standard_charge_percentage": 80.0000, "estimated_amount": 3381, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 1267.92, "standard_charge_percentage": 30.0000, "estimated_amount": 1267, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 925.58, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 925, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 4226.4, "estimated_amount": 4226, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1103.09, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1103, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 925.58, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 925, "methodology": "percent of total billed charges" }]}]} , { "description": "Treat metatarsal fracture", "code_information": [ { "code": "28485", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18681.5, "discounted_cash": 9680,"minimum": 596.19,"maximum": 16984.6,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4875.87, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4875, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 14945.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 13263.9, "standard_charge_percentage": 71.0000, "estimated_amount": 13263, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 14945.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 5137.41, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 5137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5604.45, "standard_charge_percentage": 30.0000, "estimated_amount": 5604, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 13077, "standard_charge_percentage": 70.0000, "estimated_amount": 13077, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 4091.25, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 4091, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14945.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 10774, "estimated_amount": 10773, "methodology": "case rate" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 14011.1, "standard_charge_percentage": 75.0000, "estimated_amount": 14011, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3736.3, "standard_charge_percentage": 20.0000, "estimated_amount": 3736, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 4091.25, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 4091, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14945.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14945, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 15505.7, "standard_charge_percentage": 83.0000, "estimated_amount": 15505, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 596.19, "estimated_amount": 596, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 596.19, "estimated_amount": 596, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 6351.71, "standard_charge_percentage": 34.0000, "estimated_amount": 6351, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 12143, "standard_charge_percentage": 65.0000, "estimated_amount": 12142, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 14945.2, "standard_charge_percentage": 80.0000, "estimated_amount": 14945, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 4091.25, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 4091, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 11584.9, "estimated_amount": 11584, "methodology": "case rate" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11005.7, "estimated_amount": 11005, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" }]}]} , { "description": "Treatment of toe fracture", "code_information": [ { "code": "28515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 695, "discounted_cash": 325,"minimum": 139,"maximum": 606.49,"payers_information":[{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 139, "standard_charge_percentage": 20.0000, "estimated_amount": 139, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 375.07, "estimated_amount": 375, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 337.57, "estimated_amount": 337, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 291.9, "standard_charge_percentage": 42.0000, "estimated_amount": 291, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 245.05, "estimated_amount": 245, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 569.9, "standard_charge_percentage": 82.0000, "estimated_amount": 569, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 173.77, "estimated_amount": 173, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 181.4, "standard_charge_percentage": 26.1000, "estimated_amount": 181, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 173.75, "standard_charge_percentage": 25.0000, "estimated_amount": 173, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 350.07, "estimated_amount": 350, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 191.13, "standard_charge_percentage": 27.5000, "estimated_amount": 191, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 287.56, "estimated_amount": 287, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 262.55, "estimated_amount": 262, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 576.85, "standard_charge_percentage": 83.0000, "estimated_amount": 576, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 236.3, "standard_charge_percentage": 34.0000, "estimated_amount": 236, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 275.06, "estimated_amount": 275, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 521.25, "standard_charge_percentage": 75.0000, "estimated_amount": 521, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 486.5, "standard_charge_percentage": 70.0000, "estimated_amount": 486, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 237.55, "estimated_amount": 237, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 312.56, "estimated_amount": 312, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 570.31, "estimated_amount": 570, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 494.22, "estimated_amount": 494, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 577.61, "estimated_amount": 577, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 556, "standard_charge_percentage": 80.0000, "estimated_amount": 556, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 606.49, "estimated_amount": 606, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 451.75, "standard_charge_percentage": 65.0000, "estimated_amount": 451, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 208.5, "standard_charge_percentage": 30.0000, "estimated_amount": 208, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 483.81, "estimated_amount": 483, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 152.2, "standard_charge_percentage": 21.9000, "estimated_amount": 152, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 300.06, "estimated_amount": 300, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 173.77, "estimated_amount": 173, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 405.08, "estimated_amount": 405, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 257.55, "estimated_amount": 257, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 250.05, "estimated_amount": 250, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 520.23, "estimated_amount": 520, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 493.45, "standard_charge_percentage": 71.0000, "estimated_amount": 493, "methodology": "percent of total billed charges" }]}]} , { "description": "Repair foot dislocation", "code_information": [ { "code": "28615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35904, "discounted_cash": 9680,"minimum": 558,"maximum": 29800.3,"payers_information":[{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 887.29, "estimated_amount": 887, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 28723.2, "standard_charge_percentage": 80.0000, "estimated_amount": 28723, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 29800.3, "standard_charge_percentage": 83.0000, "estimated_amount": 29800, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6221, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6221, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6251, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6251, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 23337.6, "standard_charge_percentage": 65.0000, "estimated_amount": 23337, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 28723.2, "standard_charge_percentage": 80.0000, "estimated_amount": 28723, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 28723.2, "standard_charge_percentage": 80.0000, "estimated_amount": 28723, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 887.29, "estimated_amount": 887, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 10774, "estimated_amount": 10773, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 25132.8, "standard_charge_percentage": 70.0000, "estimated_amount": 25132, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 28723.2, "standard_charge_percentage": 80.0000, "estimated_amount": 28723, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 8889, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 8889, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 26928, "standard_charge_percentage": 75.0000, "estimated_amount": 26928, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 28723.2, "standard_charge_percentage": 80.0000, "estimated_amount": 28723, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 7180.8, "standard_charge_percentage": 20.0000, "estimated_amount": 7180, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 10771.2, "standard_charge_percentage": 30.0000, "estimated_amount": 10771, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 11584.9, "estimated_amount": 11584, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 12207.4, "standard_charge_percentage": 34.0000, "estimated_amount": 12207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11005.7, "estimated_amount": 11005, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6342, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6342, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 25491.8, "standard_charge_percentage": 71.0000, "estimated_amount": 25491, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" }]}]} , { "description": "Treat toe dislocation", "code_information": [ { "code": "28665", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6988, "discounted_cash": 359,"minimum": 157,"maximum": 5800.04,"payers_information":[{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 276.84, "estimated_amount": 276, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 290.68, "estimated_amount": 290, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 1397.6, "standard_charge_percentage": 20.0000, "estimated_amount": 1397, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 276.84, "estimated_amount": 276, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 318.37, "estimated_amount": 318, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 415.26, "estimated_amount": 415, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 276.84, "estimated_amount": 276, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 290.68, "estimated_amount": 290, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 4278.93, "estimated_amount": 4278, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 4961.48, "standard_charge_percentage": 71.0000, "estimated_amount": 4961, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 1272.63, "estimated_amount": 1272, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 1530.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 1530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 285.15, "estimated_amount": 285, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 276.84, "estimated_amount": 276, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 1272.63, "estimated_amount": 1272, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 1530.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 1530, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1169, "estimated_amount": 1169, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 631.42, "estimated_amount": 631, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 1921.7, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 1921, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 373.73, "estimated_amount": 373, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 276.84, "estimated_amount": 276, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 2375.92, "standard_charge_percentage": 34.0000, "estimated_amount": 2375, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 276.84, "estimated_amount": 276, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1442, "estimated_amount": 1442, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 4188.85, "estimated_amount": 4188, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 276.84, "estimated_amount": 276, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 157, "estimated_amount": 157, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 1530.37, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 1530, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 5241, "standard_charge_percentage": 75.0000, "estimated_amount": 5241, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 285.15, "estimated_amount": 285, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 304.52, "estimated_amount": 304, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 276.84, "estimated_amount": 276, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 285.15, "estimated_amount": 285, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 157, "estimated_amount": 157, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 271.3, "estimated_amount": 271, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 4891.6, "standard_charge_percentage": 70.0000, "estimated_amount": 4891, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 448.48, "estimated_amount": 448, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 1823.87, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 1823, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 276.84, "estimated_amount": 276, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 276.84, "estimated_amount": 276, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 290.68, "estimated_amount": 290, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 276.84, "estimated_amount": 276, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 276.84, "estimated_amount": 276, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 346.05, "estimated_amount": 346, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 365, "estimated_amount": 365, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 276.84, "estimated_amount": 276, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 332.21, "estimated_amount": 332, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 276.84, "estimated_amount": 276, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 290.68, "estimated_amount": 290, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 263, "estimated_amount": 263, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 4542.2, "standard_charge_percentage": 65.0000, "estimated_amount": 4542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 276.84, "estimated_amount": 276, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 429.1, "estimated_amount": 429, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 387.58, "estimated_amount": 387, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 5800.04, "standard_charge_percentage": 83.0000, "estimated_amount": 5800, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 276.84, "estimated_amount": 276, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 276.84, "estimated_amount": 276, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 4504.14, "estimated_amount": 4504, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 5590.4, "standard_charge_percentage": 80.0000, "estimated_amount": 5590, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 429.1, "estimated_amount": 429, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 2096.4, "standard_charge_percentage": 30.0000, "estimated_amount": 2096, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 276.84, "estimated_amount": 276, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 1212.03, "estimated_amount": 1212, "methodology": "fee schedule" }]}]} , { "description": "Repair Of Toe Dislocation", "code_information": [ { "code": "28675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11097, "discounted_cash": 4396,"minimum": 558,"maximum": 11097,"payers_information":[{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 9210.51, "standard_charge_percentage": 83.0000, "estimated_amount": 9210, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 11097, "estimated_amount": 11097, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 7213.05, "standard_charge_percentage": 65.0000, "estimated_amount": 7213, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 591.73, "estimated_amount": 591, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 2896.32, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 2896, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 10774, "estimated_amount": 10773, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 7878.87, "standard_charge_percentage": 71.0000, "estimated_amount": 7878, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 8322.75, "standard_charge_percentage": 75.0000, "estimated_amount": 8322, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 6955.65, "estimated_amount": 6955, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 3348, "estimated_amount": 3348, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 8877.6, "standard_charge_percentage": 80.0000, "estimated_amount": 8877, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11005.7, "estimated_amount": 11005, "methodology": "case rate" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3329.1, "standard_charge_percentage": 30.0000, "estimated_amount": 3329, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 7767.9, "standard_charge_percentage": 70.0000, "estimated_amount": 7767, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2430.24, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2430, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 3772.98, "standard_charge_percentage": 34.0000, "estimated_amount": 3772, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2219.4, "standard_charge_percentage": 20.0000, "estimated_amount": 2219, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6624.43, "estimated_amount": 6624, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 591.73, "estimated_amount": 591, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 558, "estimated_amount": 558, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3051.68, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3051, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" }]}]} , { "description": "Fusion of foot bones", "code_information": [ { "code": "28725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28050, "discounted_cash": 17436,"minimum": 690,"maximum": 28050,"payers_information":[{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 12608.8, "estimated_amount": 12608, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 14753.9, "estimated_amount": 14753, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 22440, "standard_charge_percentage": 80.0000, "estimated_amount": 22440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 22440, "standard_charge_percentage": 80.0000, "estimated_amount": 22440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 19915.5, "standard_charge_percentage": 71.0000, "estimated_amount": 19915, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 6142.95, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 6142, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 11726.2, "estimated_amount": 11726, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 22440, "standard_charge_percentage": 80.0000, "estimated_amount": 22440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11978.4, "estimated_amount": 11978, "methodology": "case rate" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 21037.5, "standard_charge_percentage": 75.0000, "estimated_amount": 21037, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 837.68, "estimated_amount": 837, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 23281.5, "standard_charge_percentage": 83.0000, "estimated_amount": 23281, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 12742, "estimated_amount": 12742, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 13144.4, "estimated_amount": 13144, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 22440, "standard_charge_percentage": 80.0000, "estimated_amount": 22440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 18232.5, "standard_charge_percentage": 65.0000, "estimated_amount": 18232, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 18777.7, "estimated_amount": 18777, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 9537, "standard_charge_percentage": 34.0000, "estimated_amount": 9537, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 18107, "estimated_amount": 18107, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 20118.9, "estimated_amount": 20118, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 837.68, "estimated_amount": 837, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 8415, "standard_charge_percentage": 30.0000, "estimated_amount": 8415, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 22440, "standard_charge_percentage": 80.0000, "estimated_amount": 22440, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 7713.75, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 7713, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 5610, "standard_charge_percentage": 20.0000, "estimated_amount": 5610, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 19635, "standard_charge_percentage": 70.0000, "estimated_amount": 19635, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 6142.95, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 6142, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 16095.2, "estimated_amount": 16095, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 16765.8, "estimated_amount": 16765, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 21728.5, "estimated_amount": 21728, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 28050, "estimated_amount": 28050, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 6142.95, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 6142, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 15424.5, "estimated_amount": 15424, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" }]}]} , { "description": "Fusion of foot bones", "code_information": [ { "code": "28730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23352, "discounted_cash": 17436,"minimum": 690,"maximum": 23352,"payers_information":[{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 14753.9, "estimated_amount": 14753, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 16765.8, "estimated_amount": 16765, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 5114.09, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 5114, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 5954, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 5954, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 21728.5, "estimated_amount": 21728, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 11726.2, "estimated_amount": 11726, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 7005.6, "standard_charge_percentage": 30.0000, "estimated_amount": 7005, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 20118.9, "estimated_amount": 20118, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 18777.7, "estimated_amount": 18777, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 16579.9, "standard_charge_percentage": 71.0000, "estimated_amount": 16579, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11978.4, "estimated_amount": 11978, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 5114.09, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 5114, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 13144.4, "estimated_amount": 13144, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 17514, "standard_charge_percentage": 75.0000, "estimated_amount": 17514, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 4670.4, "standard_charge_percentage": 20.0000, "estimated_amount": 4670, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 23352, "estimated_amount": 23352, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 775.95, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 16095.2, "estimated_amount": 16095, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 6421.8, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 6421, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 18107, "estimated_amount": 18107, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 14083.3, "estimated_amount": 14083, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 16346.4, "standard_charge_percentage": 70.0000, "estimated_amount": 16346, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 13815, "estimated_amount": 13815, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 775.95, "estimated_amount": 775, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 15178.8, "standard_charge_percentage": 65.0000, "estimated_amount": 15178, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 12608.8, "estimated_amount": 12608, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 5114.09, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 5114, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 12742, "estimated_amount": 12742, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 19382.2, "standard_charge_percentage": 83.0000, "estimated_amount": 19382, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 13412.6, "estimated_amount": 13412, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 7939.68, "standard_charge_percentage": 34.0000, "estimated_amount": 7939, "methodology": "percent of total billed charges" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 18681.6, "standard_charge_percentage": 80.0000, "estimated_amount": 18681, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 20789.6, "estimated_amount": 20789, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 15424.5, "estimated_amount": 15424, "methodology": "fee schedule" }]}]} , { "description": "Fusion of foot bones", "code_information": [ { "code": "28740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15111, "discounted_cash": 9680,"minimum": 690,"maximum": 15111,"payers_information":[{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11978.4, "estimated_amount": 11978, "methodology": "case rate" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 10728.8, "standard_charge_percentage": 71.0000, "estimated_amount": 10728, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4533.3, "standard_charge_percentage": 30.0000, "estimated_amount": 4533, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 11333.3, "standard_charge_percentage": 75.0000, "estimated_amount": 11333, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 11726.2, "estimated_amount": 11726, "methodology": "case rate" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9822.15, "standard_charge_percentage": 65.0000, "estimated_amount": 9822, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5137.74, "standard_charge_percentage": 34.0000, "estimated_amount": 5137, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 854.73, "estimated_amount": 854, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3022.2, "standard_charge_percentage": 20.0000, "estimated_amount": 3022, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 15111, "estimated_amount": 15111, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3943.97, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3943, "methodology": "percent of total billed charges" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 12608.8, "estimated_amount": 12608, "methodology": "case rate" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 12542.1, "standard_charge_percentage": 83.0000, "estimated_amount": 12542, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 854.73, "estimated_amount": 854, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3309.31, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3309, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 10577.7, "standard_charge_percentage": 70.0000, "estimated_amount": 10577, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4155.52, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4155, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 12088.8, "standard_charge_percentage": 80.0000, "estimated_amount": 12088, "methodology": "percent of total billed charges" }]}]} , { "description": "Fusion of big toe joint", "code_information": [ { "code": "28750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18678, "discounted_cash": 9680,"minimum": 690,"maximum": 16984.6,"payers_information":[{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 4090.48, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 4090, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 14942.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3735.6, "standard_charge_percentage": 20.0000, "estimated_amount": 3735, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5603.4, "standard_charge_percentage": 30.0000, "estimated_amount": 5603, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 803.93, "estimated_amount": 803, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 13074.6, "standard_charge_percentage": 70.0000, "estimated_amount": 13074, "methodology": "percent of total billed charges" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 14942.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 16984.6, "estimated_amount": 16984, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 4090.48, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 4090, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 4090.48, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 4090, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 14008.5, "standard_charge_percentage": 75.0000, "estimated_amount": 14008, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 12140.7, "standard_charge_percentage": 65.0000, "estimated_amount": 12140, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4874.96, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4874, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 6350.52, "standard_charge_percentage": 34.0000, "estimated_amount": 6350, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 13261.4, "standard_charge_percentage": 71.0000, "estimated_amount": 13261, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 14942.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 5136.45, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 5136, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 11726.2, "estimated_amount": 11726, "methodology": "case rate" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 14942.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14942, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 12608.8, "estimated_amount": 12608, "methodology": "case rate" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 14942.4, "standard_charge_percentage": 80.0000, "estimated_amount": 14942, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 11978.4, "estimated_amount": 11978, "methodology": "case rate" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 15502.7, "standard_charge_percentage": 83.0000, "estimated_amount": 15502, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 803.93, "estimated_amount": 803, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" }]}]} , { "description": "Fusion of big toe joint", "code_information": [ { "code": "28755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14282, "discounted_cash": 9680,"minimum": 518.79,"maximum": 14282,"payers_information":[{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 10053.1, "estimated_amount": 10053, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 4898, "estimated_amount": 4898, "methodology": "case rate" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 11854.1, "standard_charge_percentage": 83.0000, "estimated_amount": 11854, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 11425.6, "standard_charge_percentage": 80.0000, "estimated_amount": 11425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 8563.77, "estimated_amount": 8563, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 14282, "estimated_amount": 14282, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 9283.3, "standard_charge_percentage": 65.0000, "estimated_amount": 9283, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 11425.6, "standard_charge_percentage": 80.0000, "estimated_amount": 11425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 2228, "estimated_amount": 2228, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3927.55, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3927, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3127.76, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3127, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 11425.6, "standard_charge_percentage": 80.0000, "estimated_amount": 11425, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 7297.82, "estimated_amount": 7297, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2856.4, "standard_charge_percentage": 20.0000, "estimated_amount": 2856, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3727.6, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3727, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3127.76, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3127, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9997.4, "standard_charge_percentage": 70.0000, "estimated_amount": 9997, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 10140.2, "standard_charge_percentage": 71.0000, "estimated_amount": 10140, "methodology": "percent of total billed charges" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 12063.8, "estimated_amount": 12063, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 10711.5, "standard_charge_percentage": 75.0000, "estimated_amount": 10711, "methodology": "percent of total billed charges" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 11170.1, "estimated_amount": 11170, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 11425.6, "standard_charge_percentage": 80.0000, "estimated_amount": 11425, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 9308.45, "estimated_amount": 9308, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 518.79, "estimated_amount": 518, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 7819.1, "estimated_amount": 7819, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 4284.6, "standard_charge_percentage": 30.0000, "estimated_amount": 4284, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 10425.5, "estimated_amount": 10425, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4855.88, "standard_charge_percentage": 34.0000, "estimated_amount": 4855, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 7670.16, "estimated_amount": 7670, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 11425.6, "standard_charge_percentage": 80.0000, "estimated_amount": 11425, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 7074.42, "estimated_amount": 7074, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 690, "estimated_amount": 690, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3127.76, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3127, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 8191.44, "estimated_amount": 8191, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 8936.11, "estimated_amount": 8936, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 7446.76, "estimated_amount": 7446, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 518.79, "estimated_amount": 518, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 11542.5, "estimated_amount": 11542, "methodology": "fee schedule" }]}]} , { "description": "Amputation thru metatarsal", "code_information": [ { "code": "28805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17118, "discounted_cash": 4396,"minimum": 746.83,"maximum": 14207.9,"payers_information":[{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 746.83, "estimated_amount": 746, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 9106.78, "standard_charge_percentage": 53.2000, "estimated_amount": 9106, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 14207.9, "standard_charge_percentage": 83.0000, "estimated_amount": 14207, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 3423.6, "standard_charge_percentage": 20.0000, "estimated_amount": 3423, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 12153.8, "standard_charge_percentage": 71.0000, "estimated_amount": 12153, "methodology": "percent of total billed charges" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 3748.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 3748, "methodology": "percent of total billed charges" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 8651.44, "standard_charge_percentage": 53.2000, "estimated_amount": 8651, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 746.83, "estimated_amount": 746, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 11982.6, "standard_charge_percentage": 70.0000, "estimated_amount": 11982, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 5135.4, "standard_charge_percentage": 30.0000, "estimated_amount": 5135, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1771, "estimated_amount": 1771, "methodology": "case rate" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 4467.8, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 4467, "methodology": "percent of total billed charges" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 5820.12, "standard_charge_percentage": 34.0000, "estimated_amount": 5820, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 3748.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 3748, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 4279.5, "standard_charge_percentage": 25.0000, "estimated_amount": 4279, "methodology": "percent of total billed charges" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 13694.4, "standard_charge_percentage": 80.0000, "estimated_amount": 13694, "methodology": "percent of total billed charges" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 3748.84, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 3748, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 6843.11, "estimated_amount": 6843, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 12838.5, "standard_charge_percentage": 75.0000, "estimated_amount": 12838, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 4707.45, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 4707, "methodology": "percent of total billed charges" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 7185.27, "estimated_amount": 7185, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 5477.76, "standard_charge_percentage": 32.0000,"standard_charge_algorithm": "Not To Exceed $9528", "estimated_amount": 5477, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 8469.3, "standard_charge_percentage": 53.2000, "estimated_amount": 8469, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 11126.7, "standard_charge_percentage": 65.0000, "estimated_amount": 11126, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" }]}]} , { "description": "Amputation of toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13187, "discounted_cash": 4396,"minimum": 302.92,"maximum": 10945.2,"payers_information":[{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Commercial", "standard_charge_dollar": 3889.58, "estimated_amount": 3889, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Workers Comp", "plan_name": "Workers Comp", "standard_charge_dollar": 6303.89, "estimated_amount": 6303, "methodology": "case rate" } ,{ "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "standard_charge_dollar": 4058.69, "estimated_amount": 4058, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Commercial", "standard_charge_dollar": 7714.21, "estimated_amount": 7714, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS HMO", "standard_charge_dollar": 3441.81, "standard_charge_percentage": 26.1000,"standard_charge_algorithm": "Not To Exceed $5954", "estimated_amount": 3441, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Preferred", "standard_charge_dollar": 2887.95, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6251", "estimated_amount": 2887, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8571.55, "standard_charge_percentage": 65.0000, "estimated_amount": 8571, "methodology": "percent of total billed charges" } ,{ "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health System Employer EPO", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice", "standard_charge_dollar": 2887.95, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6342", "estimated_amount": 2887, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Network", "standard_charge_dollar": 5242.47, "estimated_amount": 5242, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. PPO", "standard_charge_dollar": 10549.6, "standard_charge_percentage": 80.0000, "estimated_amount": 10549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA EXCHANGE", "standard_charge_dollar": 488, "estimated_amount": 488, "methodology": "case rate" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2887.95, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2887, "methodology": "percent of total billed charges" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Complementary Network Commercial", "standard_charge_dollar": 10549.6, "standard_charge_percentage": 80.0000, "estimated_amount": 10549, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3626.43, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3626, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10549.6, "standard_charge_percentage": 80.0000, "estimated_amount": 10549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicare", "plan_name": "Non-Contracted Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partners Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Humana", "plan_name": "Humana Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Provider Network Medicare", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan (PPHP) Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10945.2, "standard_charge_percentage": 83.0000, "estimated_amount": 10945, "methodology": "percent of total billed charges" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA One Health HMO and Local Plus", "standard_charge_dollar": 2637.4, "standard_charge_percentage": 20.0000, "estimated_amount": 2637, "methodology": "percent of total billed charges" } ,{ "payer_name": "Molina", "plan_name": "Molina Exchange", "standard_charge_dollar": 5073.36, "estimated_amount": 5073, "methodology": "fee schedule" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Commercial", "standard_charge_dollar": 302.92, "estimated_amount": 302, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. HMO", "standard_charge_dollar": 9230.9, "standard_charge_percentage": 70.0000, "estimated_amount": 9230, "methodology": "percent of total billed charges" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3956.1, "standard_charge_percentage": 30.0000, "estimated_amount": 3956, "methodology": "percent of total billed charges" } ,{ "payer_name": "HealthLink, Inc", "plan_name": "HealthLink, Inc. Workers Compensation", "standard_charge_dollar": 10549.6, "standard_charge_percentage": 80.0000, "estimated_amount": 10549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Commercial", "standard_charge_dollar": 1630, "estimated_amount": 1630, "methodology": "case rate" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "CIGNA COMMERCIAL", "standard_charge_dollar": 4550, "estimated_amount": 4550, "methodology": "case rate" } ,{ "payer_name": "Multiplan", "plan_name": "Multiplan Primary Network Commercial", "standard_charge_dollar": 9362.77, "standard_charge_percentage": 71.0000, "estimated_amount": 9362, "methodology": "percent of total billed charges" } ,{ "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "standard_charge_dollar": 5479.23, "estimated_amount": 5479, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Cigna", "plan_name": "Cigna Commercial New Clients", "standard_charge_dollar": 4483.58, "standard_charge_percentage": 34.0000, "estimated_amount": 4483, "methodology": "percent of total billed charges" } ,{ "payer_name": "UHC", "plan_name": "UHC Exchange", "standard_charge_dollar": 4227.8, "estimated_amount": 4227, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9890.25, "standard_charge_percentage": 75.0000, "estimated_amount": 9890, "methodology": "percent of total billed charges" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Tricare", "plan_name": "Tricare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Molina", "plan_name": "Molina Medicare MAPD", "standard_charge_dollar": 3483.71, "estimated_amount": 3483, "methodology": "fee schedule" } ,{ "payer_name": "Auto insurance", "plan_name": "Auto Insurance", "standard_charge_dollar": 10549.6, "standard_charge_percentage": 80.0000, "estimated_amount": 10549, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "standard_charge_dollar": 2817.98, "estimated_amount": 2817, "methodology": "fee schedule" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS My Blue Plus POS", "standard_charge_dollar": 4566.02, "estimated_amount": 4566, "methodology": "fee schedule" } ,{ "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 302.92, "estimated_amount": 302, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "standard_charge_dollar": 3213.13, "estimated_amount": 3213, "methodology": "fee schedule" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" }]}]} , { "description": "Partial amputation of toe", "code_information": [ { "code": "28825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12956, "discounted_cash": 4396,"minimum": 297.02,"maximum": 10753.5,"payers_information":[{ "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS PPO", "standard_charge_dollar": 3562.9, "standard_charge_percentage": 27.5000,"standard_charge_algorithm": "Not To Exceed $8889", "estimated_amount": 3562, "methodology": "percent of total billed charges" } ,{ "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "standard_charge_dollar": 3720.46, "estimated_amount": 3720, "methodology": "fee schedule" } ,{ "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "standard_charge_dollar": 297.02, "estimated_amount": 297, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Blue Choice Options", "standard_charge_dollar": 2837.36, "standard_charge_percentage": 21.9000,"standard_charge_algorithm": "Not To Exceed $6221", "estimated_amount": 2837, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Commercial", "plan_name": "Non-Contracted Commercials - 80% of BC", "standard_charge_dollar": 10364.8, "standard_charge_percentage": 80.0000, "estimated_amount": 10364, "methodology": "percent of total billed charges" } ,{ "payer_name": "Non-Contracted Medicaid", "plan_name": "Non-Contracted Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Health Alliance Medical Plan", "plan_name": "Health Alliance Medical Plan Medicare", "standard_charge_dollar": 3314.6, "estimated_amount": 3314, "methodology": "fee schedule" } ,{ "payer_name": "UHC", "plan_name": "UHC VA", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "standard_charge_dollar": 4735.14, "estimated_amount": 4735, "methodology": "fee schedule" } ,{ "payer_name": "Imagine Health Network, Inc.", "plan_name": "Imagine Health Network Commercial", "standard_charge_dollar": 1545, "estimated_amount": 1545, "methodology": "case rate" } ,{ "payer_name": "Keenan", "plan_name": "Keenan", "standard_charge_dollar": 3886.8, "standard_charge_percentage": 30.0000, "estimated_amount": 3886, "methodology": "percent of total billed charges" } ,{ "payer_name": "Meridian", "plan_name": "Meridian Medicare", "standard_charge_dollar": 3551.35, "estimated_amount": 3551, "methodology": "fee schedule" } ,{ "payer_name": "Coventry", "plan_name": "Coventry Workers Compensation", "standard_charge_dollar": 5988.7, "estimated_amount": 5988, "methodology": "case rate" } ,{ "payer_name": "Ravenswood Physicians Associates IPA ", "plan_name": "Ravenswood Physicians Associates IPA Medicare", "standard_charge_dollar": 3382.24, "estimated_amount": 3382, "methodology": "fee schedule" } ,{ "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "standard_charge_dollar": 2683.79, "estimated_amount": 2683, "methodology": "fee schedule" } ,{ "payer_name": "Aetna", "plan_name": "Aetna Auto", "standard_charge_dollar": 8421.4, "standard_charge_percentage": 65.0000, "estimated_amount": 8421, "methodology": "percent of total billed charges" } ,{ "payer_name": "SIHO", "plan_name": "SIHO Network Commercial", "standard_charge_dollar": 9717, "standard_charge_percentage": 75.0000, "estimated_amount": 9717, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN, Inc. (Healthcares Finest Network) PPO Group Health", "standard_charge_dollar": 10753.5, "standard_charge_percentage": 83.0000, "estimated_amount": 10753, "methodology": "percent of total billed charges" } ,{ "payer_name": "HFN Inc (Healthcare Finest Network)", "plan_name": "HFN Workers Compensation", "standard_charge_dollar": 5862.62, "estimated_amount": 5862, "methodology": "case rate" } ,{ "payer_name": "Meridi